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AIDS Adult Day Health Care Programs Policy Clarification

This is a revision to the policy clarification statements issued in March 2007 and June 2006. The purpose of the revision is to incorporate the creative arts therapy services policy, and to further clarify core service requirements for PT/OT services and pastoral counseling services.

Programs can bill Medicaid for the ADHCP daily rate if all the following requirements have been met:

  • the client must be in attendance at the program for a minimum of three hours on any day in which a Medicaid bill is generated; and
  • the client must receive at least one "core service" on any day in which a Medicaid bill is generated (core services are listed below); and
  • the client must receive a "minimum" of three hours of health care services for the week.

Services that may be counted towards the minimum three-hour threshold of health care services for the week include the "core" services listed below as well as health related services that are therapeutic in nature and directly or indirectly related to the core services. Under no circumstances can the health related supplementary service(s) be the primary reason for the generation of the ADHCP Medicaid claim; but the service can be counted toward the minimum three-hour threshold of health care services for the week.

Core Services

A client must receive at least one "core service" on any day that week where a Medicaid bill is generated. Services must be delivered by an appropriately credentialed staff person.

  • Medical visits (MD, PA, RN, NP)
  • Nursing visits (RN, NP)
  • 1:1 Mental health (MSW, LMSW, LCSW, LCAT, NPP, Psychologist, Psychiatrist)
  • 1:1 Nutrition (RD)
  • 1:1 Substance Abuse (CASAC, MSW, LMSW, LCSW, BA with 2 years substance abuse experience)
  • 1:1 Pastoral counseling that is indicated on the care plan (MDiv)
  • Medication groups (MD, RN, NP, PA)
  • Medical groups (MD, NP, PA, RN)
  • Substance abuse groups (CASAC, MSW, LMSW, LCSW, BA with 2 years substance abuse experience)
  • Mental health support groups (MSW, LMSW, LCSW - please refer to Department of Education for appropriate credentials for provision of mental health service)
  • Nutrition groups (RD)
  • Creative Arts Group Services (may qualify as a "core" service if the group meets all of the following criteria: is closed; is listed on the client's comprehensive care plan; has a mental health focus; and is facilitated by a LCAT)
  • PT/OT that is medically indicated for a specific condition with referral from the primary care physician, and included on the care plan
  • Health education groups (MD, PA, RN, NP)
  • Case management 1:1 (see AI CM guidelines for minimum qualifications)
  • Prevention/Risk reduction (MSW, LMSW, LCSW, RN, MD, PA, NP or CASAC, BA with 2 years of substance abuse experience)
  • Any routine assessment performed by a credentialed staff person

Comprehensive Care Plans

The comprehensive care plan should include core and health related group and individual interventions that support the rationale for the client's enrollment in the program. the frequency of such interventions should also be included. Routine program interventions that are specified in regulations (e.g. monthly medical assessment, quarterly reassessments) should not be included on the care plan.

Social/Recreational Services

Social/recreational services can only be counted towards the three hour daily program attendance requirement.

  • Community meeting/morning meeting
  • Open Art
  • Games
  • Field trips (including AIDS advocacy)
  • Current events
  • Vocational education/rehab
  • Computer skills
  • Peer support
  • NA/AA meetings on site
  • Recreational activities (softball, baseball, movies, etc.)
  • Stipend/peer led activities
  • Non-structured exercise