1. Program Definition and Services
Adult Day Health (ADH) Services in Washington provide a structurally integrated program of licensed skilled nursing, rehabilitative therapies, and psychosocial services within a group daytime setting. Unlike basic social adult day care, ADH serves individuals with complex, chronic medical or cognitive conditions who require clinical monitoring to live safely in the community. Services include:
- Clinical & Therapeutic Care: Continuous health tracking, skilled nursing interventions, complex medication administration, nutritional planning, and on-site physical, occupational, or speech-language therapies under direct physician orders
- Therapeutic Socialization: Planned cognitive stimulation, structured restorative exercises, counseling or social work coordination, and dietary-compliant meals or snacks served at least every four hours
2. Regulations
The program is governed by the following regulations:
- Washington Administrative Code (WAC) Sections 388-71-0702 through 388-71-0776: Sets forth the foundational operational, facility safety, structural, and contracting requirements for adult day services
- WAC Sections 388-106-0800 through 388-106-0815: Governs broad clinical eligibility, assessment standards, and the specific delivery criteria distinguishing adult day care from adult day health
- 182 WAC: Standards for Health Care Authority (HCA) core Medicaid enrollment, prior authorization, and electronic claims system usage
3. Licensing or Certification
Providers must secure specialized approval as an Adult Day Health Center from the Department of Social and Health Services (DSHS) or its authorized local Area Agency on Aging (AAA) designees.
4. Responsible State Agency
The program is managed by the Washington State Department of Social and Health Services (DSHS) via the Aging and Long-Term Support Administration (ALTSA), which handles center contracting, quality monitoring, and annual on-site facility surveys, alongside the Washington State Health Care Authority (HCA) for overarching Medicaid reimbursement policy.
5. Application Process
Applicants must first build out or acquire a fully accessible physical facility that complies with building codes and the Americans with Disabilities Act (ADA). The agency then submits a comprehensive network provider application to DSHS/ALTSA or the regional Area Agency on Aging. Following structural approval and passing a physical center walkthrough, the provider activates their billing profile through the HCA's ProviderOne portal.
6. Required Documentation
Providers typically need to submit:
- Active Washington Secretary of State business registration (UBI number) and an organizational Type 2 NPI
- Official local zoning approvals and a passed facility fire marshal clearance certificate
- An ADH-specific Policy and Procedure Manual detailing emergency evacuation drills, infection control protocols, and Medication Administration Record (MAR) keeping
- Verifiable criminal background check clearances run through the DSHS Background Check Central Unit (BCCU) for all stakeholders and staff
- Up-to-date professional state licenses for all on-site clinical employees (RNs, LPNs, Therapists)
- Certificates of insurance confirming general commercial and professional liability coverage meeting state-contracted minimum profiles
7. Timeline for Approval
Securing a physical site, obtaining local permits, and engineering the clinical space requires 2 to 3 months. The subsequent DSHS qualification review, site inspection, and final ProviderOne system activation generally require an additional 2 to 4 months.
8. Pre-Application Process
Prospective providers must complete key foundational steps prior to formal application. They must establish their legal corporate entity with the Secretary of State, purchase or lease a compliant commercial property, establish tax accounts with the Department of Revenue, and secure an EIN along with a matching medical Type 2 National Provider Identifier (NPI).
9. Pre-Application Training
While there is no multi-day training academy, the facility director and clinical supervisor must demonstrate a clear understanding of the WAC 388-71 standards. Direct care staff must complete foundation training in universal precautions, emergency procedures, and documentation, supplemented by mandatory quarterly center in-service training sessions.
10. Additional Notes
- Centers must maintain a strict direct care staffing ratio of at least one direct care staff member for every six participants (1:6) present in the center at all times
- Under WAC guidelines, an approved ADH center must employ a core team consisting of an Administrator, a Program Director, a Registered Nurse (RN), an Activity Coordinator, a Social Worker, and a licensed Therapist (PT, OT, or SLP). The Administrator and Program Director positions may be held by the same individual
- The center's on-site nurse must be a Registered Nurse (RN) holding a valid Washington license with a minimum of one full-time equivalent year of applicable clinical nursing experience
- Adult Day Health is funded in Washington primarily through the Community Options Program Entry System (COPES) waiver, the Community First Choice (CFC) program, or via integrated Program of All-Inclusive Care for the Elderly (PACE) models
Why Choose Waiver Consulting Group?
Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any stat
With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Wheth
To get started, click the link to request portal access