016.06.71-213.600. Adult Day Health Services (ADHS)
AR ADC 016.06.71-213.600Arkansas Administrative CodeEffective: October 1, 2022
Effective: October 1, 2022
Ark. Admin. Code 016.06.71-213.600
016.06.71-213.600. Adult Day Health Services (ADHS)
Procedure Code | Required Modifier | Description |
|---|---|---|
S5100 | TD, U1 | Adult Day Health Services, 8-20 Units Per Date of Service |
S5100 | TD | Adult Day Health Services, 21-40 Units Per Date of Service |
Adult day health services facilities are licensed to provide a continuing, organized program of rehabilitative, therapeutic and supportive health services, social services and activities to participants who are functionally impaired and who, due to the severity of their functional impairment, are not capable of fully independent living.
Adult day health services programs provide rehabilitative and health services directed toward meeting the health restoration and maintenance needs of the participant that cannot be provided by adult day care programs. Adult day health services are appropriate only for participants whose facility-developed care plans specify one or more of the following health services:
Participants may receive adult day health services for 8 or more units (2 or more hours) per day, not to exceed 40 units (10 hours) per day when the service is provided according to the participant's written PCSP. Adult day health services of less than 8 units (2 hours) per day are not reimbursable by Medicaid. Adult day health services may be utilized up to 200 units (50 hours) per week, not to exceed 920 units (230 hours) per month.
Participants who are present in the facility for more than 20 units (5 hours) a day (procedure code S5100, modifier TD) must be served a nutritious meal that equals one-third of the Recommended Daily Dietary Allowances. Therefore, participants are not eligible to receive a home-delivered meal on the same day they receive more than five (5) hours of adult day health services. Additionally, participants who attend an adult day health services for more than 20 units (5 hours) are not eligible to receive Attendant Care services on the same date of service unless authorized by the PCSP/CC NURSE.
Adult day health services providers are required by licensure to maintain a daily attendance log of participants. See Section 214.000 for additional documentation requirements.
NOTE: As stated in this manual, home-delivered meals may not be provided on the same day for a participant who attends adult day services, adult day health services, or facility-based respite care for more than 20 units (5 hours). The time of day the participant is receiving day services or respite services is also a factor in the application of this policy. The time of day services are received will be reviewed by the PCSP/CC NURSE and/or DHS audit staff and considered when determining any duplication in services for participants participating in the ARChoices Waiver program.
Providers must consider the following to determine whether a home-delivered meal is billable for a participant receiving day services or facility-based respite services on a specific date of service.
If an ARChoices participant is receiving day services or facility-based respite between the hours of 11:00 a.m. and 1:30 p.m. and the noon meal is routinely served to others at the facility during this time frame, the noon meal must also be served to the participant. A home-delivered meal is not allowable on the same date of service. This is true regardless of the total number of day services or respite units provided.
Credits
Adopted Dec. 27, 2015. Amended Oct. 6, 2016; Jan. 1, 2019; Oct. 1, 2022.
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.71-213.600, AR ADC 016.06.71-213.600
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