Medicaid Services Provided in an Adult Day Health Setting

Beneficiaries received at least one health service on 60 percent of service days.

Within broad Federal Medicaid requirements, individual States establish the specific requirements that must be met for Medicaid reimbursement of adult day health services. We focused on the 12 States that, as of December 31, 2007, provided nursing- and therapy-focused adult day health services through a State plan benefit to primarily elderly or disabled individuals. We requested records from adult day health centers that provided services to beneficiaries. Thirty-one centers did not respond to our repeated requests. Using medical reviewers, we reviewed a random sample of 300 adult day health service days from the last 6 months of 2007.

We found that meals and/or snacks were the only documented services for Medicaid beneficiaries on 34 percent of service days in an adult day health setting. We also found that approximately 43 percent of therapy services were provided by staff who lacked required supervision. Finally, although documentation associated with most service days included timely assessments, in some cases documentation lacked appropriate physician orders or was inconsistent with plans of care.

We recommend that CMS (1) specify what services are required for Medicaid reimbursement of adult day health services, (2) direct States to enforce supervision requirements for staff who provide therapy services in Medicaid adult day health centers, and (3) take appropriate action to address the centers that did not respond to repeated data requests.

In its written comments on our draft report, CMS concurred with all of our recommendations and outlined the steps it will take to implement them.