Adult Day Services in Idaho offer structured programming during daytime hours for individuals with disabilities, chronic illnesses, or aging-related needs. These services are authorized under Idaho’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan options, supporting community living, preventing isolation, and providing respite for caregivers.

1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid
Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Adult Day Services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Adult Day Services meet Medicaid HCBS standards for community integration, participant rights, and person-centered care

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2. ADULT DAY SERVICE OVERVIEW

Adult Day Services provide supervised, structured care and support outside the participant's home in a licensed or certified facility, enhancing quality of life and promoting independence.

Approved providers may deliver:

• Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
• Health monitoring (basic, non-invasive checks under non-nursing supervision)
• Structured recreational, social, and educational activities
• Nutritional services, including meals and snacks
• Community outings and integration activities
• Personal care, medication reminders (non-skilled), and mobility assistance
• Respite and caregiver support services

Programs are individualized based on each participant’s needs and preferences as outlined in their Individualized Service Plan (ISP)

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Idaho Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment
• Obtain local permits if operating a facility (building safety, health, and occupancy compliance)
• Maintain general liability and professional liability insurance
• Develop operational policies ensuring participant safety, service delivery, and emergency preparedness

4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Adult Day Services through Idaho’s Medicaid Management Information System (MMIS)

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, staff qualifications, operational policies, and insurance certificates
• Provide facility floor plans, activity schedules, participant intake forms, and emergency plans

Program Readiness Review:

• IDHW reviews provider readiness including facility safety compliance, staff qualifications, Medicaid billing systems, and participant rights policies

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for Adult Day Services (typically billed hourly or daily)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Idaho Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Proof of general and professional liability insurance
• HCBS-Compliant Policy & Procedure Manual including:
• Participant intake, assessment, and activity planning procedures
• ADL support, mobility assistance, and medication reminder protocols
• Safety plans for emergencies, disasters, and participant health crises
• HIPAA confidentiality, participant rights, and grievance handling procedures
• Staff credentialing, background checks, and ongoing training documentation
• Medicaid billing, daily attendance tracking, and audit readiness systems

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6. STAFFING REQUIREMENTS

Role: Adult Day Program Manager / Administrator
Requirements: Experience in human services, healthcare, or senior services, background screening clearance

Role: Direct Support Staff / Activity Coordinators
Requirements: High school diploma or GED, CPR/First Aid certification, training in personal care assistance and activity facilitation, background screening clearance

All staff must complete:

• HIPAA confidentiality and participant rights training
• Emergency preparedness, infection control, and abuse prevention training
• Participant-centered planning and community integration training
• Annual refreshers on safety protocols and Medicaid compliance

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7. MEDICAID WAIVER PROGRAMS

The following Idaho Medicaid Waivers authorize Adult Day Services:

• Aged and Disabled (A&D) Waiver
• Developmental Disabilities (DD) Waiver (for community-based day supports)

Approved providers may deliver:

• Daytime supervision and skill-building supports
• Structured activities promoting socialization and life skills
• Basic health monitoring and personal assistance during program hours

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8. TIMELINE TO LAUNCH

Phase: Business Formation and Facility Setup
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 1–2 months

Phase: Idaho Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing System Configuration and Claims Readiness
Timeline: 30–45 days

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9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Medicaid Division
Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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Waiver Consulting Group supports adult day centers, community-based organizations, and disability service providers in launching Medicaid-compliant Adult Day Services under Idaho’s HCBS waiver programs.

10. SCOPE OF WORK