Adult Day Health (ADH) services in Massachusetts provide nursing oversight, personal care, case management, therapeutic activities, and meals in a structured community setting. These services are regulated by the Massachusetts Department of Public Health (DPH) and reimbursed by MassHealth (Medicaid) for eligible adults through a medical model of day care.

1. GOVERNING AGENCIES

Agency: Massachusetts Department of Public Health (DPH)
Role: Licenses and inspects Adult Day Health programs per 105 CMR 158.000

Agency: MassHealth (Massachusetts Medicaid)
Role: Reimburses ADH services and defines clinical eligibility and operational standards

Agency: Executive Office of Health and Human Services (EOHHS)
Role: Establishes programmatic and rate-setting guidance for ADH providers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures compliance with Medicaid and HCBS waiver regulations

2. ADULT DAY HEALTH SERVICE OVERVIEW

Adult Day Health programs provide structured services for adults with chronic illness, physical/cognitive impairments, or behavioral health needs, and who are at risk of institutionalization.

Core services include:

• Skilled nursing services (e.g., vitals, medication administration, wound care)
• Assistance with ADLs (e.g., bathing, dressing, toileting)
• Case management and care coordination
• Meals and dietary support
• Therapeutic and recreational activities
• Transportation (optional/additional service)

ADH centers typically operate 5–6 hours per day, Monday through Friday, and participants attend regularly based on need and authorization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To operate an ADH program in Massachusetts, you must:

• Obtain licensure through the DPH Bureau of Health Care Safety and Quality under 105 CMR 158
• Meet facility requirements for square footage, accessibility, and infection control
• Employ licensed staff including an RN, activity director, case manager, and aides
• Maintain participant records, care plans, and clinical documentation
• Enroll with MassHealth for reimbursement

4. DPH LICENSURE PROCESS

Step 1: Business Formation

• Register entity via https://www.mass.gov/orgs/secretary-of-the-commonwealth
• Obtain EIN and NPI

Step 2: Site Acquisition and Buildout

• Identify location that meets fire safety, ADA, and health codes
• Design rooms for clinical services, activities, dining, and rest areas

Step 3: DPH Application and Policies Submission

Submit licensure application with required attachments:

• Staffing plan, org chart, policies/procedures, sample forms
• Lease/deed, floor plans, food service documentation
• Infection control plan and emergency preparedness plan

Step 4: DPH Survey and Approval

• Pass on-site inspection
• Receive licensure to operate as an Adult Day Health center

5. MASSHEALTH ENROLLMENT & SERVICE AUTHORIZATION

Step 1: Enroll as a MassHealth Adult Day Health Provider
Step 2: Submit provider contract and rate documentation
Step 3: Accept referrals through MassHealth LTSS programs, SCO (Senior Care Options), or ACOs
Step 4: Provide services per care plans and submit billing through the LTSS Provider Portal

6. REQUIRED DOCUMENTATION

• Articles of Organization or LLC registration
• IRS EIN and Type 2 NPI
• DPH ADH license
• MassHealth provider contract

Comprehensive policy and procedure manual including:

• Nursing protocols and MAR logs
• Service and care plan templates
• ADL documentation and attendance logs
• Participant intake and consent forms
• Emergency and disaster plans
• Infection control and cleaning logs
• Staffing supervision records
• Client rights, privacy, and grievance procedures

7. STAFFING REQUIREMENTS (PER DPH 105 CMR 158)

Required Roles:

• Registered Nurse (RN): Full-time during operating hours; oversees clinical services
• Case Manager (e.g., LSW): Coordinates participant services and PCP communication
• Activity Director: Plans and delivers therapeutic programs
• Personal Care Staff (CNA/HHA): Assists with ADLs
• Program Director (Admin): Ensures operational compliance and supervision

Recommended:

• On-call medical director (physician)
• Social worker, dietitian, behavioral health consultant

Training Requirements:

• CPR, first aid, and medication administration
• Infection control and universal precautions
• Person-centered planning and cultural competence
• Abuse, neglect, and elder protection reporting
• HIPAA and documentation standards

8. MASSHEALTH ELIGIBILITY & REIMBURSEMENT

Participants must:

• Be MassHealth-eligible (Standard or CommonHealth)
• Have medical necessity for nursing supervision or ADL assistance
• Be at risk for institutionalization without ADH support

MassHealth reimburses per level of care:

• Basic Level – For participants needing basic nursing and ADL support
• Complex Level – For those requiring more intensive clinical interventions
• Transitional Level – For participants being discharged from a facility

Rates are set by EOHHS and billed through MassHealth LTSS or contracted MCOs.

9. TIMELINE TO LAUNCH

Phase: Business and Facility Setup
Timeline: 2–4 weeks

Phase: Policy Manual and Staffing Plan
Timeline: 3–5 weeks

Phase: DPH Application and Site Readiness
Timeline: 8–12 weeks

Phase: MassHealth Enrollment and Referral Activation
Timeline: 4–6 weeks (can overlap)

10. CONTACT INFORMATION

Massachusetts Department of Public Health (DPH)
Website: https://www.mass.gov/orgs/department-of-public-health
Licensing Unit: https://www.mass.gov/guides/apply-for-a-health-care-facility-license

​MassHealth Provider Enrollment
Website: https://massfinance.ehs.state.ma.us

​MassHealth Adult Day Health Program
Program Manual: https://www.mass.gov/doc/adult-day-health-provider-manual

​LTSS Provider Portal
Billing and documentation: https://ltss.mass.gov

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10. SCOPE OF WORK

• Business registration (LLC, EIN, NPI)
• Facility design consultation and DPH compliance prep
• Policy & procedure manual development (per 105 CMR 158)
• Staffing plan, job descriptions, and training logs
• MAR, ADL, and nursing documentation templates
• Medicaid enrollment support and LTSS billing tools
• Client intake packets, family consent forms, and grievance procedures
• Audit readiness and referral networking templates