Adult Day Care Program Manual

Frequently Asked Questions

Reminder: Providers need to review 19 CSR 30-90 requirements in their entirety at: https://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp

ADC programs receiving Medicaid waiver funding through DHSS or DMH or federal reimbursements are also required to comply with those program requirements.

May I begin providing ADC Services to participants before I am licensed by DHSS?

You may provide services to no more than four (4) individuals in your ADC program without a license.

If I submitted an application and my floor plan was not approved for a license, may I submit a new floor plan for a different location, without submitting another application?

No. If you decide to change locations, you must submit a new application.

If I decide to change locations, may I use my current license for that location?

No. A license to operate is only good for the location listed on the license. If you want to change locations, you must complete the entire application process prior to moving participants and operating in the new location.

I am licensed by DHSS and DMH. Some of the requirements are different for each program. How do I know what regulation I should follow?

In order to be in compliance with both programs, you need to ensure that you are in compliance with the most stringent requirements at all times. For instance, DMH regulation staffing ratios are more stringent than DHSS regulation staffing ratios. In order to be in compliance with both programs, you would need to staff with the higher ratios at all times.

Are there any grants available to assist with funding for my ADC program?

DHSS is not aware of any organizations available to assist with the completion of a proposal or any grants available to defray the cost of starting a business.

How soon after I am licensed will participants be placed into my program?

State agencies do not place clients in ADC programs. We also do not recommend one ADC program over another to participants.

How do I change my operating hours on my license?

Please submit a letter requesting the change in hours, with the director’s signature, to:

Section for Long-Term Care Regulation
Licensure and Certification Unit
P.O. Box 570
Jefferson City, MO 65102

A revised license will be sent to the ADC program.

How do I apply to be a Medicaid provider for Adult Day Care or Aged/Disabled waiver services?

If an ADC wants to become a provider for ADC or Aged/Disabled Waiver Services, you will want to do the following:

Establish a National Provider Identifier number: https://nppes.cms.hhs.gov
Review Medicaid enrollment process and complete the enrollment package: http://mmac.mo.gov/providers/provider-enrollment/home-and-community-bas…
Questions? Contact Missouri Medicaid Audit and Compliance (MMAC): (573) 751-3399
- Email: MMAC.IHSCONTRACTS@DSS.MO.GOV

Where do I find out more information on the Adult Day Care Food Program?

The Child and Adult Care Food Program (CACFP) provides meal reimbursement to eligible adult day care centers. To determine if your center is eligible and/or to apply, review the following information:

https://health.mo.gov/living/wellness/nutrition/foodprograms/cacfp/adult_care.php [NEEDS LINK]

Questions? Contact the Community Food and Nutrition Assistance program:

Telephone: (573) 751-6269
Toll-free: (800) 733-6251
Email: CACFP@health.mo.gov

Can a licensed Nurse Practitioner perform the medical assessment and sign the physician's orders in lieu of the physician?

If the licensed Nurse Practitioner is acting as the “physician’s designated agent”, then yes, he/she can perform and sign the medical assessment: 19 CSR 30-90.050 (3).

No, a licensed Nurse Practitioner cannot sign physician’s orders in lieu of the physician: 19 CSR 30-90.050 (8) (D) B. Medications or treatments may not be administered without an order signed by a licensed physician.

What is the requirement for a nurse in an ADC program?

In SLCR’s regulations related to ADC, there are specific regulations that indicate when an ADC would need to have a nurse perform a duty. These include:

Reviewing modified diets every 6 months (if modified diets are provided at the ADC) - can also be completed by a qualified dietician or the physician.
Administration of medications/system of medication distribution or physician ordered treatments, and communication with physician related to medication/treatments. 19 CSR 30-90.050 (8) (D).

The ADC is also required to provide the appropriate type and number of personnel to care for persons in their ADC, in accordance with their plan of care. If the plan of care required a service that would be recognized as a nursing service (such as tube feeding, colostomy care, etc) then the inspectors would review the participant’s plan of care to determine how this is being implemented. Otherwise, in an ADC that offers medical services, the nurse would need to be “available”, but that may or may not require him/her to be onsite at all times. Again, whether a nurse is required to be physically onsite is dependent on the care needs and care plans of the individual participants you serve.

Who can pass medications in an ADC?

19 CSR30-90.050 (8) (D): The licensed nurse shall be the only individual authorized to receive, control and manage the medication and drug program. The licensed nurse shall be responsible for the following:

A safe, effective system of identifying, handling and storing each participant’s medications.
A system for administering and storing medications that is reviewed not less than every ninety (90) days by a licensed nurse.
Administration of medications and treatments…”

Can a Certified Medication Technician or Aide (CMT or CMA)? No.
Can a Level I Medication Aide? No.
Can a Physician or Pharmacist? Yes.

What associations are involved in Adult Day Care programs?

The Missouri Adult Day Services Association (MOADSA)
2420 Hyde Park, Suite A
Jefferson City, MO 65109
(573) 634-3566

Missouri Alliance for Home Care (MAHC)
2420 Hyde Park, Suite A
Jefferson City, MO 65109
(573) 634-7772

Missouri Association of Rehabilitation Facilities (MARF)
205 E. Capital Ave., Suite 100
Jefferson City, MO 65101
(573) 635-1631

Missouri Assisted Living Association (MALA)
2707B Hyde Park Rd.
Jefferson City, MO 65109
(573) 635-8750

LeadingAge Missouri
3412 Knipp Dr. Suite 102
Jefferson City, MO 65109
(573) 635-6244

Missouri Association of Nursing Home Administrators (MANHA)
915 Southwest Blvd, Ste J
Jefferson City, MO 65109
(573) 63 -5345

Missouri Health Care Association (MHCA)
236 Metro Dr.
Jefferson City, MO 65109
(573) 893-2060

Adult Day Care Program Manual

Frequently Asked Questions

Table of Contents

On this page