Hawaii adult day care center certificate of approval: rules, fees and the OHCA process

Two agencies, one certificate

Hawaii’s adult day care rules have an unusual home. The standards are Hawaii Administrative Rules chapter 17-1424, a Department of Human Services (DHS) chapter adopted under HRS 346-83, effective June 29, 1992 and last amended and compiled October 4, 2001 ⁠¹. The rule text still says “the department” means DHS. In practice the Department of Health’s Office of Health Care Assurance (OHCA) runs the program. OHCA’s State Licensing Section lists “Adult Day Care Center” among the facility types it handles ⁠³, publishes the roster of certified centers ⁠⁴, and collects the fees. The DOH fee rule, HAR 11-103.1, defines an adult day care center as “a licensed facility that meets the requirements of chapter 17-1424” ⁠².

The credential is called a certificate of approval, but the rule defines that term as “a license issued by the department authorizing the operation of an adult day care center” ⁠¹. Treat it as a license in contracts, leases and funding applications.

To reach the program, call the State Licensing Section at (808) 692-7400 or write to Department of Health, State Licensing Section, 601 Kamokila Boulevard, Room 361, Kapolei, Hawaii 96707 ⁠³. The rule requires “a signed departmental application form” ⁠¹, but OHCA’s State Licensing Section page links only the roster of certified centers ⁠³⁠⁴, not an application form. Ask the section which form it currently uses and how to get it, and whether it will send the form by mail or email.

Who needs a certificate, and who does not

A center needs a certificate if it gives regular supportive care to four or more disabled adult participants, with or without charging a fee ⁠¹. Each part of that definition has a precise meaning in the rule ⁠¹:

• Disabled adult means an adult living alone, or living with a spouse, relative or friend, who is unable to function independently and needs regular protective and supportive care.
• Regular care means care at fixed or uniform intervals. Temporary, occasional or casual care does not count.
• Supportive care means a supportive environment, personal care, supervision, and social and psychological stimulation to help prevent deterioration.

Two kinds of program fall outside the chapter ⁠¹:

• A center run solely for education, social or recreational activities, such as a senior club with no personal care or supervision.
• A facility licensed by the Department of Health as an adult day health facility.

An operator who wilfully makes a false statement or violates the chapter can be cited and fined by a court up to $5,000 ⁠¹. The rule does not separately describe a penalty for operating without a certificate, so ask OHCA how it handles unlicensed centers.

Adult day care or adult day health: choose the model first

Hawaii licenses day programs for adults at two levels, and the second is much harder to open.

If your participants need skilled nursing, wound care or therapy during the day, you are describing adult day health. For that license, OHCA requires an approved certificate of need from the State Health Planning and Development Agency (SHPDA), or a SHPDA letter saying one is not needed, before it accepts your written request ⁠⁵. You also send policy manuals on governing body, personnel, patient care, emergency and disaster planning, infection control, in-service training, medical records and program evaluation. OHCA warns that because of existing contractual obligations it may not be able to schedule initial licensure for “several months” ⁠⁵. The rest of this guide covers the adult day care center.

Who is already operating

OHCA’s adult day care center list, updated March 2026, shows 28 certified centers: 23 on Oahu, 3 on Maui, 1 on Molokai and 1 on Hawaii Island. No center is listed on Kauai or Lanai ⁠⁴. Certified capacities run from 6 participants to 105 ⁠⁴. The list also shows certificate dates, and most terms run about two years, which matches the 24-month maximum in the rule ⁠¹⁠⁴.

What the application must contain

The 60-day decision clock starts only when the application is complete ⁠¹. Under HAR 17-1424-3, a complete application contains ⁠¹:

1. A signed departmental application form

2. A written statement of services and operating policies

   for the proposed center.

3. Organization and administration information

4. Staffing information

   how many staff, their duties, education and work experience.

5. Floor plans

   of the center and its location on the property.

6. Compliance reports

   for county building and zoning codes, fire codes and state sanitation requirements.

The sixth item means your county building department, county fire department and, where it applies, the Department of Health must sign off before the state can treat the file as complete. The rule says the department arranges those inspections and keeps the building, fire and sanitation reports on file ⁠¹.

The operating policy statement must cover eight items ⁠¹:

• the center’s name and address;
• the operating individual, organization or sponsoring agency;
• admission policies;
• the maximum number of adults the center is equipped to serve;
• hours of operation, and whether meals or transportation are provided;
• fees;
• the policy and plans for routine and emergency medical care;
• the program and services.

Building, space and fire rules

Your building has to meet county building ordinances, state law including architectural barrier requirements, local fire codes and DOH rules. It also has to meet the county building code for buildings used for children’s day care ⁠¹. Raise that classification with the county building department before you sign a lease. A space approved for an office or a church hall may not meet it.

The fire rules ask for more than equipment ⁠¹:

• The director writes an evacuation plan and submits it to the fire department for approval. The plan includes training for staff and participants.
• Fire drills at least once a month, with every participant and staff member taking part.
• A fire alarm system that meets local fire codes. Centers that give care for any part of a night need an automatic fire alarm system.
• Fire extinguishers, inspected at least once a year and kept charged.

A center in an area exposed to tsunami, flooding or similar disasters must have an evacuation plan to a place of refuge under local civil defense rules ⁠¹. On much of Hawaii’s coastline, this plan will be part of what you prepare.

Staff, director and health clearances

Each center needs a director responsible for the whole program. The director must have basic knowledge and training or experience in caring for disabled adults, and must name a staff member to take charge whenever the director is absent ⁠¹. The rule sets no degree or license for the director.

The staffing rules in HAR 17-1424-12 ⁠¹:

• Ratio: one regular staff member to six participants. The director may count toward the ratio; volunteers may not.
• First aid and CPR: every staff member must hold current certification. At least one certified staff member must be at the center whenever participants are present and must go on field trips.
• Health exam: each staff member needs a complete physical by a licensed physician within one year before hire and every year after, including a tuberculosis clearance that meets DOH guidelines. Reports stay at the center.
• Volunteers: all need a TB clearance from within one year before starting. Volunteers working 10 or more hours a week also need a complete health exam.
• A staff member must greet every participant on arrival.

The center must also carry comprehensive liability insurance ⁠¹. HAR 17-1424 itself sets no background check requirement, but state law does. HRS 321-15.2 covers licensed adult day care centers as healthcare facilities and directs the Department of Health to require background checks (criminal history and abuse records) of operators, direct patient access employees and adult volunteers ⁠⁸, and HRS 846-2.7 specifically authorizes the Department of Health to run criminal history checks on adult day care center operators, employees, new employees, subcontracted service providers and adult volunteers ⁠⁹. Ask OHCA which check forms and fingerprint or name-inquiry process apply to your staff.

Medications, meals and the daily program

Families bring each participant’s medication to the center every day, in the original labeled pharmacy container. The center stores it out of participants’ reach and returns it at the end of the day ⁠¹. Staff may remind and supervise but may not give medication, with one exception. An LPN or RN may give it, or unlicensed staff delegated by an RN under HAR chapter 16-89, subchapter 15, but only with the participant’s physician’s signed authorization ⁠¹.

If you serve meals, they must approximate the federal type A school lunch standard, with snacks between meals ⁠¹. The program must include ⁠¹:

• arts and crafts, hobbies, reading or other quiet activities;
• daily exercise as tolerated or as the physician prescribes;
• outings at least twice a month;
• rest periods every morning and afternoon;
• help with toileting and personal care;
• isolation of anyone with symptoms of a communicable disease until medically cleared;
• counseling or referral when a participant or family needs more help.

If you provide transportation, you must follow Public Utilities Commission rules and HRS chapter 286 ⁠¹.

Admissions and records

Before admission, each applicant needs a physical by a licensed physician within 90 calendar days before admission. The report covers diagnosis, a TB clearance and any special care instructions. The center then needs an annual exam or statement of health ⁠¹. Staff interview the applicant and family before admission, and participants must be told the center’s fees in writing ⁠¹.

The admission form records name, address, birth date, sex, next of kin, family physician, written consent to call another physician, and the hours the person will attend ⁠¹. Ongoing records include the staff roster with training and health records, daily activity schedules, daily menus, attendance and a health record for each participant ⁠¹.

From application to certificate, in order

1. Choose the model

   If you plan nursing services, follow the SHPDA certificate-of-need route under HAR 11-96 instead ⁠⁵.

2. Confirm the building with the county

   It must meet the code for children’s day care buildings and the zoning for your site ⁠¹.

3. Request the application from the State Licensing Section

   at (808) 692-7400 ⁠³.

4. Prepare the six application items

   , including floor plans and the services and policy statement ⁠¹.

5. Get the county building, fire and sanitation sign-offs

   , and have the fire department approve your evacuation plan ⁠¹.

6. File the complete application

   The filing date is the date the complete application is received ⁠¹.

7. State survey

   DOH surveys every applicant before issuing an initial certificate. It then confirms full compliance in writing or asks for a written plan of correction ⁠².

8. Pay the $1,000 fee within 10 days

   of the notice of full compliance ⁠².

9. Receive and post the certificate

   It names the center, its address, its maximum capacity and the certificate period, and must hang in a prominent place ⁠¹.

The department has to decide within 60 days of the complete application. If it misses that date, you receive a temporary certificate from day 61 until it decides ⁠¹. A center with minor deficiencies, meaning ones that do not risk participants’ life, health or safety, can get a temporary certificate for up to three months. You submit a written correction plan, and the department may grant one three-month extension, plus a final three-month extension for causes outside your control, such as a strike. After that, the temporary certificate is revoked ⁠¹.

Fees

Fees are non-refundable. Pay them to “State of Hawaii OHCA SF” by corporate check, bank or financial-institution check, money order, or electronically if available. Personal checks and cash are not accepted ⁠². If you fail to pay the renewal fee, the certificate is forfeited on the renewal date ⁠². The fee schedules are dated May 1, 2022, in a rule effective September 16, 2022 ⁠².

Renewal, changes and enforcement

A certificate lasts no more than 24 months ⁠¹. At least 30 days before it expires, file a renewal application with an updated services and policy statement and staff information. The department then re-evaluates the center ⁠¹. Pay the $700 renewal fee by that same 30-day mark ⁠².

The certificate cannot be transferred when the holder stops operating the center, so a buyer needs its own certificate. Any change in the physical facilities, location or operating policies triggers a review ⁠¹. To close, give the department at least 30 days’ written notice ⁠¹.

If the center falls out of compliance, the department sends a written notice listing the violations and gives at least 33 days from mailing to correct them, after which it may suspend or revoke the certificate. Imminent danger to participants brings immediate suspension ⁠¹. You may appeal a proposed suspension or revocation in writing to the department director within 10 working days of the notice. A hearing officer then decides ⁠¹. The department director may also grant exceptions to the chapter’s requirements at their discretion ⁠¹.

How centers are paid through Medicaid

Hawaii’s Medicaid program, QUEST Integration, pays for adult day care as a home and community-based service. Med-QUEST memo QI-2604 (February 6, 2026) published these fee-for-service rates for services from January 1, 2026 ⁠⁷. The rates are the same as in the 2025 memo QI-2501:

The memo was addressed to the QUEST Integration health plans and HCBS providers. It says the managed care plans’ rates “may differ from these amounts” and may vary by plan, so a center serving Medicaid members negotiates with each plan it contracts with ⁠⁷.

Related Hawaii licenses

If your participants need overnight care, you need a residential license instead: an adult residential care home or an assisted living facility. Personal care in clients’ homes needs a home care agency license, and skilled nursing at home needs a home health agency license. For other states, see the adult day care license overview.

Sources

1. 1
   Hawaii Department of Human Services, Hawaii Administrative Rules, Title 17, Chapter 1424: Licensing of Adult Day Care Centers Checked 12 Oct 2026 · Back to text ↑
2. 2
   Hawaii Department of Health, Hawaii Administrative Rules, Chapter 11-103.1: Licensure and Certification Fees for Health Care Facilities and Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Hawaii Department of Health, Office of Health Care Assurance, State Licensing Section Checked 12 Oct 2026 · Back to text ↑
4. 4
   Hawaii Department of Health, Office of Health Care Assurance, Adult Day Care Center list (updated March 2026) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Hawaii Department of Health, Office of Health Care Assurance, Opening an Adult Day Health Center Checked 12 Oct 2026 · Back to text ↑
6. 6
   Hawaii Department of Health, Hawaii Administrative Rules, Chapter 11-96: Freestanding Adult Day Health Centers Checked 12 Oct 2026 · Back to text ↑
7. 7
   Hawaii Department of Human Services, Med-QUEST Division, Memo QI-2604: Fee-For-Service Rates for HCBS Effective 01.01.2026 Checked 12 Oct 2026 · Back to text ↑
8. 8
   Hawaii State Legislature, Hawaii Revised Statutes 321-15.2: Background checks Checked 12 Oct 2026 · Back to text ↑
9. 9
   Hawaii State Legislature, Hawaii Revised Statutes 846-2.7: Criminal history record checks Checked 12 Oct 2026 · Back to text ↑

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