As the push for aging in place grows, Adult Day Centers will become increasingly important. And the rules governing them will grow as well. The certification of these centers is important. In this article we look at one state’s requirements – Oregon – as a template for other states and for providers contemplating entry into this market.
Certification by the Department of Human Services(DHS)is intended to fulfill the Centers for Medicare and Medicaid Services(CMS)requirements of “state certified” adult day service programs with the purpose of continuing eligibility criteria for Medicare beneficiaries.
To receive Seniors and People with Disabilities Division (SPD) certification and be eligible for a DHS Medicaid contract, Adult Day Services (ADS) programs must complete the certification process that includes the following:
- Contacting SPD to schedule an initial certification on-site visit.
- Provide a cover letter detailing qualifications and specific experience in delivering adult day services.
- Completion of an Adult Day Services Medicaid Provider Application.
- Completion of the ADS self assessment demonstrating the program meets the standards for adult day services.
- Completion of a cost justification for the purpose of establishing a state contracted daily rate.
- Participation in a follow-up on-site inspection by a representative(s) of SPD.
SPD will complete an on-site certification assessment form after the visit, citing standards as “met” or “unmet”. If all standards are met, SPD will certify the ADS program. If any of the standards are unmet, the application for certification will be denied. The ADS program may bring the unmet standards into compliance and request that SPD complete a site certification reassessment. If the denial is upheld after a site certification reassessment, the ADS program may request an informal conference in writing within ten business days of receipt of the denial notice.
Certification for an adult day services program may continue for up to two years from the effective date as long as the ADS program complies with the standards for certification. SPD may perform an unannounced on-site certification review at anytime during the certification period to assure quality and safety standards continue to be met.
As increasing numbers of ADS participants present with medical conditions, it is important that the ADS program have a service plan based on services needed and the ADS program’s ability to provide those services. The service plan must include the following:
- Intake Screening
The intake screening must be completed by the ADS prior to admission in order to determine the appropriateness of the ADS program for the participant and to determine that the participant’s needs are within the scope of the ADS program.
An application or enrollment agreement must be completed and include the applicant’s personal identifying information; information regarding health, safety and emergency needs; identification of services to be provided; a disclosure statement that describes the ADS program’s range of care and services; criteria for admission and discharge; and fees and arrangements for payment, including insurance coverage or other payment sources.
A written assessment of the participant must include functional abilities and disabilities, strengths and weaknesses, personal habits, preferences and interests, likes and dislikes, medical condition, medications, personal care, assistance required with activities of daily living, a statement on the ability to live independently, and any other information helpful to developing the service plan, such as life history.
- Written Service Plans
The service plan must include realistic objectives that are both long-term and short-term. including: specify number of days per week of attendance; define the services to be provided; explain how the service will meet the assessed need; and identify staff responsible for providing or monitoring service delivery.
- Coordination of Care
If coordination of care is needed and the participant is receiving services from another agency or resides in a community based care setting, the ADS service plan should be developed to acknowledge and not duplicate the services provided by that agency or facility.
- Service Documentation and Reassessment
Progress notes on each participant must be written at least quarterly and must reflect a review of the service plan and the participant's status in regard to the services. Reassessing the participant's needs and reevaluating the appropriateness of the service plan must be completed not less than semiannually.
Source DHHS, State of Oregon