Louisiana adult day health care license: LDH rules, staffing and the 1,500-foot rule
In Louisiana, a medical-model day program for two or more functionally impaired adults (17 or older) who are not related to you needs an Adult Day Health Care (ADHC) license from the Louisiana Department of Health, Health Standards Section. The license costs $600 a year as published on October 12, 2026. You need Fire Marshal plan approval before you apply, and the center has to pass an on-site survey before it can open.
Contents12 sections
Key takeaways
- An ADHC license is required once a medical-model day program serves two or more unrelated functionally impaired adults aged 17 or older. Without it, you cannot operate or bill Medicaid.34
- A new center cannot open within 1,500 feet of another ADHC center unless the same organization owns and manages both.1
- The Office of State Fire Marshal must approve your plans before LDH will license the center. The initial packet also needs Fire Marshal and Office of Public Health occupancy inspections.12
- Required staffing: a nurse on site daily, a 1:9 direct service worker ratio, and a director, social services designee, program manager and food service supervisor. At small capacities some of these roles can be combined.1
- The center must provide transportation, and no participant may ride more than one hour on a single trip.1
- Medicaid pays through the ADHC Waiver, run by the Office of Aging and Adult Services. Rates are set per quarter hour, and the center must file annual cost reports.89
Quick facts
| Agency | Louisiana Department of Health, Health Standards Section (HSS) |
|---|---|
| Licensing threshold | 2 or more unrelated functionally impaired adults, age 17+ |
| Fee | $600 initial, $600 annual renewal, non-refundable |
| Financial proof | $50,000 line of credit; $300,000 general and $300,000 professional liability |
| Space | 40 sq ft usable indoor space per participant |
| Staffing ratio | 1:9 direct service worker to participants |
| License term | 1 year; renewal packet due 30 days before expiry |
Fees and packet contents as published on the LDH Health Standards Section ADHC page, checked on October 12, 2026.
Which Louisiana license fits your day program
Louisiana has two licenses for adult day programs, and you should pick one before you look for a building.
The Adult Day Health Care (ADHC) license covers a “medical model” program. It meets medical, nursing, social, care management and personal care needs and uses licensed professionals in a center-based nursing program 3. You need the license once you serve two or more functionally impaired adults who are not related to the owner or operator 3. “Functionally impaired” means people 17 or older whose physical or mental impairment means they need supervision 3. Under R.S. 40:2120.43, nobody may establish or operate an ADHC program, or be reimbursed by Medicaid for one, without an LDH license 4. LDH is the only licensing authority for ADHC centers in the state 1.
The Adult Day Care module of the Home and Community-Based Services (HCBS) provider license covers a structured group program of health, social and support services in a protective setting. That module applies to groups of ten or more functionally impaired adults aged 17 or older who are not related to the provider 6. It is a social program attached to the HCBS license, not a separate ADHC license. If you plan a social day program, see the Louisiana HCBS provider license guide.
The ADHC license is what Medicaid’s ADHC Waiver pays for (see below). The rule also expects real clinical capacity: every center provides nursing services, medication administration and transportation 1. Other states’ rules for this business type are compared on the adult day care license page.
The 1,500-foot rule and other site limits
Check your site against the location rules before anything else:
- Distance. A new ADHC center cannot be within 1,500 feet of another adult day health care center unless the same organization owns and manages both 1.
- Inside another licensed program. An ADHC center inside a program licensed by LDH needs its own staff, space and storage. The host program must still meet the rules of its own license 1.
- Inside a nursing home. Space counted toward the nursing center’s license cannot also count toward the ADHC. If the ADHC uses nursing center bedroom space, the nursing center’s licensed bed count drops by the beds tied to that space 1.
- Hours. The center must be open at least five continuous hours a day 1 and at least five days a week 1.
Louisiana has no certificate of need 7. The Facility Need Review list, which gates some provider types before licensure, covers certain HCBS modules, hospice, pediatric day health care, some behavioral health services and ICF-IID. ADHC centers are not on that list as of October 12, 2026 7.
Fire Marshal plan review comes first
No ADHC can be licensed without written approval from the Office of State Fire Marshal (OSFM). OSFM must approve the plans and specifications in advance, and the center must be built to them 1. This applies to new construction, additions, renovations, any change in service, and opening an ADHC in a current or former healthcare facility 1. You submit plans online through OSFM’s process. A cover letter must explain the scope of work, the services offered, participant capacity, location and any special features of the population you serve 1. New construction must also meet the Office of Public Health (OPH) requirements. Plans must be prepared by or under the direction of a licensed architect or engineer 1.
An OSFM approval stays valid as long as construction begins within 180 days of the notice 1. HSS lists the OSFM healthcare plan review line as 225-925-4920 2.
The LDH secretary may waive building or clinical-operation requirements. You request a waiver in writing on LDH forms and must show it will not compromise participants’ health, safety or quality of care 1. An internal committee reviews the request. The secretary’s written decision is final and cannot be appealed. A waiver does not carry over to a new owner or a new location 1. Waivers granted before January 1, 2024 remain in effect but can be reviewed or revoked 1.
Space, furnishings and the building
| Item | Requirement |
|---|---|
| Activity space | At least 40 sq ft of indoor space per participant, not counting hallways, offices, restrooms, storage rooms or kitchens 1 |
| Toilets and hand-washing | At least one of each per 12 participants. At least two toilets if men and women are served. All must be accessible to people with disabilities 1 |
| Isolation | A separate room or partitioned area for a participant who becomes ill; a bed or recliner is allowed 1 |
| Dining | Tables and chairs for all participants 1 |
| Kitchen (if any) | Meets health and sanitation requirements and is sized for the meals you prepare 1 |
| Parking | Enough parking for safe daily drop-off and pick-up 1 |
| Floors and exits | Non-slip floors and steps; doorways and passageways kept clear 1 |
The space rule sets your capacity. The initial license states the maximum number of participants 1, and you may not exceed that number on any day or at any time 1.
Who you must hire
Chapter 42 names four “key” staff positions and a few other required roles 1. Degrees must come from an institution that is nationally accredited under the federal Higher Education Act 1.
| Position | Qualification | Minimum time |
|---|---|---|
| Director | Bachelor’s degree in a human services field such as social work, nursing, education or psychology, or 8 years of supervisory experience in human services instead | Not set by hours |
| Nurse (RN or LPN) | Current Louisiana nursing license | On site daily for 8 hours, the hours the center is open, or the hours participants are present, whichever is less |
| Social services designee or social worker | Designee: bachelor’s degree in a human services field (two years of experience can replace each year of college). Social worker: BSW or MSW | At least 10 hours a week |
| Program manager | Not specified | At least 10 hours a week |
| Food service supervisor | ServSafe certification | At least 10 hours a week |
| Direct service workers | Unlicensed staff who give hands-on care | 1 full-time worker per 9 participants |
How many full-time people you need for the key positions depends on licensed capacity 1:
- 15 or fewer participants: at least one full-time person or full-time equivalent (FTE). One FTE may hold up to three key positions.
- 16 to 30 participants: at least two FTEs. One person may hold no more than two key positions.
- More than 30 participants: at least three FTEs, and each key position is filled by its own FTE.
Regardless of size, a CPR-certified staff member must be on site whenever participants are present 1. If the nurse leaves after eight hours while participants remain, the social services designee or the program manager must stay on duty 1. A registered nurse sits on the interdisciplinary team. The RN reviews each participant’s medications at least monthly and whenever they change, and gives health in-service training to staff and participants at least quarterly 1. Agency RNs, LPNs or nurse aides must come from a licensed nurse staffing agency 1.
Screening and training. Before offering a job to a direct care applicant, you must get three references, check the Direct Service Worker Registry, and obtain a statewide Louisiana State Police criminal background check 1. Staff need a tuberculosis screening on the OPH schedule 1. Each direct care worker needs at least 20 hours of face-to-face training a year, not counting orientation and normal supervision 1. New direct care staff cannot provide care until their competency is documented 1. Keep personnel files for three years after an employee leaves 1.
Services the center must provide every day
Louisiana sets a minimum service package, so the license does not fit a drop-in social club. Each center must provide 1:
Personal care
Individual training or help with activities of daily living such as toileting, grooming and walking.
Health programming
Health and nutrition counseling, daily health education and an individual daily exercise program.
Recreation
An individual, goal-directed recreation program, plus a planned daily schedule of individual and group activities.
Meals
One hot, balanced meal and two snacks each day. The noon meal must provide one-third of the recommended dietary allowances, and a licensed registered dietitian plans and approves the menus.
Nursing
Vital signs at least monthly, medications and treatments given under physician orders, and individual self-medication plans where appropriate.
Transportation
Rides to and from the center at the start and end of the program day.
The transportation rules are strict 1. Drivers, whether employees or contractors, need a valid chauffeur’s license or a CDL with a passenger endorsement if one applies. The center needs liability insurance on the transport, and at least one staff member trained in first aid and CPR rides in every vehicle. You must transport any participant within your licensed region, but no trip may last more than one hour. LDH must approve a mileage-radius limit before you can use one.
Within 20 days of admission, the interdisciplinary team must assess each participant and write an individualized service plan, then reassess at least quarterly 1. You must run emergency drills at least once every three months 1.
The application packet and the order of steps
HSS will not process an application until every form, attachment and the fee have arrived 2.
Check the site
Confirm the 1,500-foot spacing and local approvals. HSS asks for proof of zoning, occupational license and local fire ordinance approvals where they apply 12.
Get OSFM plan review approval
Keep the approval letter and the floor plan with OSFM’s green approval stamp; both go in the packet 2.
Build or renovate, then pass occupancy inspections
Request an inspection from your OSFM district office: Baton Rouge 225-925-4914, Lafayette 337-886-1273, New Orleans 504-219-4600, Shreveport 318-676-7145 or Monroe 318-362-4696 2. For the OPH sanitarian recommendation, call 225-342-8954 and complete the OPH plan review questionnaire 2.
Line up financing and insurance
You need a line of credit of at least $50,000 from a federally insured, licensed lender, plus general and professional liability insurance of at least $300,000 each 12.
Run owner background checks
Every owner needs a statewide criminal background check through the Louisiana State Police or an approved agency 12.
Submit the packet
It includes the ADHC licensing application, the $600 fee and a payment transmittal form. Add a letter of intent with the center’s name, address and, for new construction, the completion date. Also include Form HSS-1513L (disclosure of ownership), the OSFM letter and stamped plan, the OSFM and OPH inspection reports, background checks, financial and insurance proof, a CLIA certificate or waiver if you will do lab testing, an 8x11 floor sketch, your days and hours of operation, and your Articles of Incorporation 12.
Fix gaps within 90 days
If the packet is incomplete, you have 90 days to send what is missing. After that the application closes, and you start over with a new fee 12.
Request the initial survey within 90 days
Once LDH approves the packet, it sends instructions for requesting the announced initial licensing survey. You must tell LDH you are ready within 90 days of receiving them, or the application closes 1.
Pass the survey
HSS surveys on site before issuing the license 25. A fully compliant center gets a full license. If problems do not threaten participants, LDH may issue a provisional license for up to six months. Problems that threaten health or safety lead to denial 1.
Send fees with the transmittal form to LDH Licensing Fee, P.O. Box 734350, Dallas, TX 75373-4350. Pay by company check, cashier’s check or money order. Mail the application documents to the Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821-3767 2. HSS lists Kaci Owens as the ADHC contact ([email protected], 225-342-6298) as of October 12, 2026 2.
PACE organizations have a few extra steps. Their applications must include an emergency preparedness attestation (required since March 1, 2018) 2. After initial licensure, a PACE-operated center can ask for “accredited status.” LDH may then accept the PACE program agreement in place of routine on-site surveys, but there is no fee discount 1.
Fees, renewal and keeping the license
| Item | Amount or deadline |
|---|---|
| Initial license fee | $600, non-refundable 2 |
| Annual renewal fee | $600 2 |
| Renewal packet due | At least 30 days before the license expires 1 |
| Change of name, address, contact details or key staff | Report in writing within 5 working days 1 |
| Change of ownership | Written notice to HSS at least 15 days before the effective date. The new owner files an application with a CHOW fee 1 |
| Plan of correction after a cited survey | Within 10 calendar days of receiving the statement of deficiencies 1 |
| Closing the center | 30 days’ written notice to each participant, the participant’s physician, HSS, OAAS and the support coordination agency before closing 1 |
The license lasts one year and expires on the last day of the twelfth month after it was issued 14. It covers one address and one licensee. It cannot be sold or transferred, and it must be posted where visitors can see it 14. The renewal packet needs a current fire inspection report, a current OPH inspection report, the fee, and proof that the $50,000 line of credit has stayed in place without a break 1. Centers in New Orleans must also submit the city Fire Marshal report 2. A center under revocation or a provisional license cannot change ownership 1. The rule requires a fee for any change that alters the license and for a duplicate license but does not state the amounts 1. LDH says a CHOW fee is usually the same as the renewal fee unless more changes are needed, and that a name change costs $25 to print a new license 1011. The official sources reviewed do not publish the duplicate-license fee, so ask the HSS ADHC program desk (225-342-0138) before you pay 11.
To keep the license, the center must stay operational. At least one employee must be on duty during operating hours, and the center must have admitted and served at least two participants in the 12 months before its licensure resurvey 1. A center that stops operating loses the license immediately, apart from the rule’s exceptions for declared and non-declared emergencies 1.
Once the initial license is issued, LDH’s licensing surveys are unannounced 1. LDH can issue a provisional license of up to six months to an existing center in several cases: more than five deficiencies in one survey, more than three validated complaints in a licensed year, a deficiency that put a participant at risk of serious harm or death, or failure to correct cited deficiencies within 60 days 1.
How Louisiana ADHC centers get paid
The main Medicaid payer is the ADHC Waiver, run by the Office of Aging and Adult Services (OAAS). To qualify, a person must meet long-term care Medicaid eligibility, be 22 or older and meet nursing home level of care 8. This is a narrower group than the 17-and-older population the license allows you to serve 3. Waiver slots go first to priority groups (protective services referrals, people discharged from a hospital within 30 days, Medicaid-only nursing home residents), then first-come, first-served by request date 8. The waiver also pays for support coordination, home-delivered meals, personal emergency response systems and “ADHC health status monitoring,” which means staff calls on days a participant does not attend 8.
The Medicaid participation standards set the business terms 9:
- Provider agreement. The center must sign a provider agreement with LDH 9.
- Quarter-hour billing. Payment is a per-quarter-hour rate under a prospective payment system. Nothing is paid for services delivered before the plan of care is approved 9.
- Hours cap. Waiver ADHC services may not exceed 10 hours a day or 50 hours a week 9.
- No cherry-picking. You cannot refuse someone who chooses your center unless you document that you cannot meet their health, safety and welfare needs, and you must notify OAAS immediately when you refuse 9.
- Attendance. Not attending for at least 36 days in a calendar quarter is a discharge criterion for a participant 9.
- Cost reports. Annual cost reports are due by the last day of September after the reporting period closes. Keep supporting records for at least five years 9.
Rates. LDH’s Rate Setting and Audit page says ADHC providers have been paid a quarter-hour rate instead of a daily rate since July 1, 2011 12. The only rate file it links is for July 1, 2024 to June 30, 2025. It lists direct care at $2.08, care-related at $0.30, administrative and operating at $0.98 and property at $0.12 per quarter hour, a $3.48 subtotal, with transportation shown separately 13. That file is not a current rate, so ask LDH Rate Setting and Audit for the rate in effect when you open. The official sources reviewed do not publish step-by-step Medicaid enrollment instructions for a new ADHC center beyond the provider agreement with LDH 9, so ask the OAAS ADHC contact how and when to enroll.
Recent rule changes
LDH’s Health Standards Section amended Chapter 42 in March 2024 (Louisiana Register Vol. 50, pp. 391-393) 1. The amendment changed the introduction, definitions, licensure requirements (including the OSFM plan review and waiver procedure), the initial application process and the emergency-inactivation provisions 1. As of October 12, 2026, the HSS page links the August 2025 copy of the rule (July 2025 LAC edition) 2, and this guide follows it.
If your plans move toward residential care, see the adult residential care provider guide.
Sources
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- 7 Louisiana Department of Health, Health Standards Section: Facility Need Review Checked 12 Oct 2026 · Back to text ↑
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- 9
- 10
- 11
- 12
- 13
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Related guides
Louisiana and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Louisiana (this guide) | Adult Day Health Care (ADHC) License; Adult Day Care module of the HCBS Provider License | ADHC: 2+ impaired adults; HCBS day care module: 10+ | $600 initial, $600 annual renewal, non-refundable |
| Texas | Day Activity and Health Services (DAHS) facility license | Daytime services for 4 or more unrelated adults | $75 per three-year license (26 TAC 559.37, as published on October 12, 2026); $25 late renewal fee |
| Arkansas | Adult Day Care (ADC) or Adult Day Health Care (ADHC) license | 4+ functionally impaired adults, 2 to 24 hours a day, outside their homes | $5.00 per slot (20 CAR 408-205, as published on October 12, 2026) |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.