Home and Community Based Services Manual
3.51 Adult Day Care (Aged and Disabled Waiver)
Revised - January 2018
Adult Day Care (ADC) is the continuous care and supervision of a disabled adult in a licensed adult day care setting. Services include but are not limited to assistance with activities of daily living, planned group activities, food services, client observation, skilled nursing services as specified in the plan of care, and transportation. Planned group activities include socialization, recreation and cultural activities that stimulate the individual and help the participant maintain optimal functioning. The provider must arrange or provide transportation to the adult day care facility at no cost to the participant. Reimbursement will be made for up to 120 minutes per day of transportation related to transporting an individual to and from the Adult Day Care setting. Meals provided as part of ADC shall not constitute a "full nutritional regimen" (3 meals per day).
- Authorization of ADC is funded through the Aged and Disabled Waiver.
- All ADC participants must meet the following eligibility criteria:
- At least sixty-three (63) years of age;
- In active Medicaid status (Medicaid Eligibility).
- Participants who are eligible for Medicaid on a spenddown basis may be authorized to receive the ADC during periods when they meet their spenddown liability.
- A participant is responsible for the cost of services received during periods of time when they have not met their spenddown liability.
- Participants who receive Medicaid due to eligibility for Blind Pension (BP) may not be authorized for the ADC.
- Participants in a ‘Transfer of Property penalty’ may not be authorized for the ADC.
- Authorization of the ADC does meet the requirements for an individual to be eligible for Home and Community Based (HCB) Medicaid.
- Have an appropriate Medicaid Eligibility (ME) Codes; and
- Meet nursing facility level of care.
- ADC services shall be authorized for:
- Up to 10 hours per day for a maximum of 5 days per week of which no more than 120 minutes, or eight (8), 15 minute units per day may be related to transporting an individual to and from the adult day care setting.
- ADC shall be included in the overall HCBS Cost Maximums cost of care for the participant.
- ADC authorized together with other Aged and Disabled Services and Medicaid State Plan HCBS [i.e., Basic Personal Care (PC), Advanced Personal Care (APC), Authorized Nurse Visits (RN), and Consumer-Directed Model Personal Care (CDS)] shall not exceed 100% of the average statewide monthly cost for care in a nursing facility.
NOTE: When the care plan includes an authorization for RN services, the cost of one RN visit shall be excluded from the calculation of a care plan’s cost.
- ADC is provided by Adult Day Care facilities licensed by DHSS, Division of Regulation and Licensure (DRL) with a Medicaid provider agreement with the Department of Social Services (DSS), Missouri Medicaid Audit and Compliance Unit (MMAC). Payment is made to the ADC provider on behalf of the participant.
- Restrictions:
- Individuals who reside in a nursing facility, Residential Care Facility (RCF) or Assisted Living Facility (ALF) licensed by DHSS, DRL are not eligible for ADC.
- Participants authorized for certain services through the Department of Mental Health (DMH) may not be eligible for services as outlined in this policy. Staff shall refer to the DMH Service Coordination Policyfor guidance on coordination of services for participants authorized for DMH services.
- Services received from the ADC are determined by the individual plan of care developed by the participant, ADC personnel, and the participant’s physician. The individual plan of care is developed every six (6) months by the ADC and includes the amount, duration and scope of treatment and services to be provided. The individual plan of care shall be available to Division of Senior and Disability Services (DSDS) staff or its designee upon request. Depending on the individual plan of care, the participant may receive the following organized services as a component of receiving the ADC:
- Leisure-time and exercise activities - planned recreational and social activities;
- Counseling services - assistance to participants and families with personal, social, family or adjustment problems;
- Rehabilitative services - occupational, physical, and speech therapy;
- Activities of daily living - such as assistance with walking, toileting, or feeding;
- Medication management and nursing services - by a licensed nurse;
- Meals - to include physician ordered special or modified diets and snacks; and
- Up to 10 hours per day for a maximum of 5 days per week of which no more than eight (8), 15 minute units per day may be related to transporting an individual to and from the adult day care setting.