Massachusetts Adult Day Health program license: DPH rules under 105 CMR 158.000

The license is a health care license, issued by DPH

The licensed category in Massachusetts is the Adult Day Health Program, regulated by the Department of Public Health’s Division of Health Care Facility Licensure and Certification ⁠². DPH defines an ADH program as any entity, “however organized, whether conducted for profit or not for profit,” that supports families and caregivers so the participant can live in the community, provides nursing care, supervision and health-related support services in a structured group setting to people 18 or older with physical, cognitive or behavioral health impairments, and is community-based and non-residential ⁠³.

Under 105 CMR 158.005, no person may establish or maintain a program without an original license from DPH ⁠¹. DPH licenses ADH programs “regardless of whether the program participates in MassHealth” ⁠², so a private-pay-only program still needs the license.

Licensure has only applied since 2015. Programs already operating before January 2, 2015 had to file an application by May 1, 2015 ⁠¹. DPH’s April 2015 circular letter was blunt about everyone else: programs established after January 2, 2015 “must file an application, be inspected and receive a license prior to providing service to participants” ⁠⁹. You cannot open and apply later.

Two related questions are not answered by the official sources checked. The rule sets no minimum number of participants. And DPH’s pages do not say whether a purely social day program, one with no nursing care, needs any state license. If your program would offer only social activity and no nursing care, DPH’s licensing pages do not say whether any state license applies; ask the Division at (617) 753-8000 before you open. If your plan includes 24-hour care or housing, you are outside ADH entirely; see the Massachusetts assisted living residence certification guide.

What DPH does not require: no Determination of Need, no Plan Review

Many Massachusetts health facilities must go through DPH’s Determination of Need program or its Plan Review Program. DPH’s 2015 circular states that adult day health programs “do not require review by the Determination of Need Office or Plan Review Program” ⁠⁹. Your space is checked instead through the Program Capacity Form, a floor plan, the attestation of physical-plant compliance, local sign-offs and the DPH licensing inspection ⁠¹⁠⁶⁠⁷.

Space comes first: capacity is a square-footage calculation

DPH sets your licensed capacity based on the square footage of your participant area ⁠¹. The Program Capacity Form spells out the formula: the maximum number of participants in care at one time may not exceed the participant area divided by at least 50 square feet per participant, and may not exceed 12 participants per participant bathroom ⁠⁶. “Participant area” means space used for services, therapeutic activities and dining. It does not include reception, storage, offices, restrooms, corridors or service areas. If a kitchen is also used for activities, half of its floor area counts ⁠⁶.

So pick a site by measuring usable program space, not gross square footage. A 2,500-square-foot participant area supports at most 50 participants on space, and then only if it also has enough bathrooms.

The floor plan you submit must label every room’s use, give the length and width of every room and space (including closets, corridors and the lobby), show which toilets are accessible and mark any space dedicated to participants with Alzheimer’s disease and related disorders ⁠⁶.

If you share a building with other services, the program must operate solely within its licensed space ⁠¹. If you cannot meet a physical plant rule, DPH has a Physical Plant Waiver Request Form, one form per request ⁠³⁠⁴.

Local approvals you need before DPH will act

105 CMR 158.007 makes three local documents a prerequisite for the license: any applicable local board of health certificates, a current occupancy permit and a current local fire inspection certificate ⁠¹. DPH supplies its own Local Fire Certificate form, which the head of your local fire department signs to record whether the site complies with local fire ordinances ⁠⁸. If you prepare food on site, the checklist asks for Board of Health kitchen approval ⁠⁴.

A license covers one program site, so a second location needs its own license ⁠¹. You must also control the premises: the applicant must own the site or hold a lease that gives it the rights DPH considers necessary to operate ⁠¹.

Who can be the applicant, and the suitability review

DPH reviews the “suitability and responsibility” of the applicant ⁠¹. For an entity, “applicant” includes every shareholder owning 5% or more, every officer and every director ⁠¹. The Suitability Form asks for all individuals and entities with a 5% or greater ownership interest, a resume for each owner, officer and director, and a DPH CORI (criminal record) form ⁠⁵. The signer certifies under M.G.L. c. 62C, s. 49A that the applicant is current on state taxes, employee reporting and child support withholding ⁠⁵. Original applications are signed under the pains and penalties of perjury ⁠¹.

After licensure, ownership and control changes must be filed with DPH within 30 days ⁠⁵⁠¹.

Staffing minimums

Massachusetts writes its ADH staffing rules as hard numbers in 105 CMR 158.032 ⁠¹.

The Program Director’s minimum hours scale with licensed capacity: at least 10 hours a week for 35 or fewer participants, 20 hours for 36 to 72, and 35 hours for 73 or more ⁠¹. The program must be open at least Monday through Friday and be non-residential ⁠¹. The director must be at least 21 and have a high school diploma or equivalent, at least two years of experience working with adults in a health care setting (paid or volunteer) and at least two years of related managerial experience ⁠¹. A licensed nurse may not serve as Program Director and also count toward the required nursing hours ⁠¹. If the director resigns or is dismissed, DPH must be told in writing within two business days, with the replacement’s name and qualifications ⁠¹.

Your RN must have at least two years of recent experience in direct care of adults or chronically disabled people ⁠¹.

Screening and training

Before hiring staff or accepting volunteers, you must check references, job history, CORI and the Nurse Aide Registry ⁠¹. Personnel files must show a pre-employment physical done within 12 months before hire, a physical at least every two years after that, and an annual TB risk assessment ⁠¹. Other training rules ⁠¹:

• An organized orientation for every new employee.
• At least 12 hours of relevant in-service training per year for staff who interact with participants.
• Training for all staff on Alzheimer’s disease and related disorders, behavior management and group process skills.
• CPR and basic first aid certification for licensed nurses and program aides; emergency-procedure training for everyone in direct contact with participants.
• At least 8 hours of orientation for any program aide who has not already been found competent through a training or competency evaluation program.

What the program must run before and after opening

Beyond staffing, 105 CMR 158.000 requires structures you should draft before you apply, because you attest to them:

• Participant and Family Advisory Council. At least half of the members must be current or former participants and their families ⁠¹.
• Written policies and a disaster plan. Emergency procedures for fire and other emergencies, developed with local and state fire and safety experts and coordinated with the local fire department’s requirements ⁠¹.
• Quality program. A data-driven Quality Assessment and Performance Improvement (QAPI) program with a QAPI committee ⁠¹.
• Enrollment rules. No one may be enrolled without a written order from a primary care provider and written consent ⁠¹. The initial comprehensive assessment is due within 14 days of enrollment, and the RN must notify the primary care provider of the plan of care at least every six months ⁠¹.
• Required services. Nursing care, service coordination, therapeutic activities, dietary services and medication management, plus rehabilitation services arranged or coordinated through licensed therapists and interpreter services as necessary ⁠¹. Programs serving people with and without dementia must provide separate space, as necessary, for activities for participants with advanced dementia ⁠¹.
• Meals. At least one third of each participant’s daily nutritional needs, including at least one hot mid-day meal ⁠¹.
• Incident reports. Unanticipated deaths, full or partial evacuations and fires must be reported to DPH immediately ⁠¹.

The application packet, in order

DPH takes ADH applications by mail only ⁠³.

1. Lock down the site

   Get the lease or deed, and measure the participant area and count participant bathrooms against the 50-square-foot and 12-per-bathroom limits ⁠¹⁠⁶.

2. Get local sign-offs

   Certificate of occupancy, local fire inspection on DPH’s Local Fire Certificate form, and any board of health certificates, including kitchen approval if you cook on site ⁠¹⁠⁴⁠⁸.

3. Complete the Suitability Form

   List every 5%+ owner, officer and director, attach resumes and CORI forms, and attach the fee check payable to “Commonwealth of Massachusetts” ⁠⁵. If your answers trigger it, add the Suitability Application Disclosure Form ⁠³.

4. Complete the Program Capacity Form with a dimensioned floor plan

   ⁠⁶.

5. Complete the Clinical Information and Attestation Form

   This 21-page form asks for your days and hours of operation, expected daily census and scheduled RNs, LPNs, aides and volunteers per day. You attest, section by section, that you comply with 105 CMR 158.000 ⁠⁷.

6. Add the conditional forms

   Physical plant waiver requests, the ADH Approved Test Form and CMS Form 116 (the federal CLIA application) if you will perform lab tests and do not already hold a CLIA certificate ⁠³⁠⁹.

7. Add the HCFRS enrollment forms

   These are the forms for DPH’s Health Care Facility Reporting System. The checklist lists Forms A through D; the application page marks Form C (facility agreement) and Form D (one per user) as required. Leave the license number blank ⁠³⁠⁴⁠⁹.

8. Mail the packet with the Application Checklist on top

   to: Licensure Coordinator, Department of Public Health, Division of Health Care Facility Licensure and Certification, 67 Forest Street, Marlborough, MA 01752 ⁠³⁠⁴.

9. Licensing inspection

   DPH will not approve an original license until it has inspected or investigated and found you compliant and suitable ⁠¹. Applying also gives DPH permission to inspect ⁠¹.

DPH will not accept an application unless it is complete and all required fees are paid ⁠¹. DPH does not publish a processing time for ADH licenses.

Fees

The Application Checklist lists an “Application Fee” ⁠⁴, and the Suitability Form tells applicants to attach a check for “the appropriate fee” according to DPH’s fee table ⁠⁵. However, DPH’s 2015 circular stated that “no fee for licensure has been established yet” for ADH ⁠⁹, and DPH’s health care facility fee schedule (last updated December 14, 2018) lists fees for nursing and rest homes, hospitals, clinics, hospices and clinical laboratories, with no ADH category ⁠¹⁰. No official source checked on 2026-10-12 states the ADH fee amount. Ask the Division at (617) 753-8000 what amount and payee to put on the check before you mail the packet.

After licensure: inspections, changes and closure

DPH may inspect a program at any time without notice ⁠¹. After any inspection that finds violations, you get a deficiency statement and must return a plan of correction within ten business days ⁠¹. Changes to any information you have filed must be reported within 30 days ⁠¹.

A license cannot be transferred, so buyers file their own application ⁠¹. The rule refers to renewal and expiration, but the rule text does not state a license term or renewal cycle, and no DPH page checked gives one. Ask the Division when your first license will expire so you can calendar the renewal filing. The local fire certificate is required again at renewal ⁠⁸.

Getting paid by MassHealth

MassHealth sets its own provider rule for ADH, 130 CMR 404.000. To enroll you must sign a MassHealth provider contract, hold a DPH license under 105 CMR 158.000, accept MassHealth payment as payment in full, agree to periodic quality inspections and attend any provider orientation EOHHS requires ⁠¹¹.

MassHealth pays only for members who meet clinical criteria: a primary care provider’s order; a chronic or post-acute medical, cognitive or mental health condition that needs active monitoring and nurse assessment; and either at least one skilled service or regular hands-on help or cueing with qualifying activities of daily living ⁠¹¹. You must get prior authorization before the first day of service and every year after, based on a clinical assessment ⁠¹¹. Payment is at a Basic or Complex level as authorized, at rates set in 101 CMR 310.00, and the rates do not include room and board ⁠¹¹⁠¹². Transportation between home and the program can be provided directly or through a subcontractor and is paid separately under EOHHS rates ⁠¹¹.

The 2026 moratorium. CMS approved a temporary six-month MassHealth provider enrollment moratorium for ADH effective May 19, 2026 ⁠². DPH states that the moratorium “does not impact initial licensure,” so you can still get licensed, but a new program cannot count on MassHealth billing while the freeze is in place. MassHealth directs questions to its Customer Service Center at 1-800-841-2900 ⁠². Six months from May 19 runs to about mid-November 2026. DPH’s page as checked on 2026-10-12 announces no extension or end date, so ask MassHealth before you sign a lease whether it will still be closed when your license issues.

Sources

1. 1
   Massachusetts Department of Public Health, 105 CMR 158.000: Licensure of Adult Day Health Programs Checked 12 Oct 2026 · Back to text ↑
2. 2
   Massachusetts Department of Public Health, Division of Health Care Facility Licensure and Certification, Adult Day Health Licensure Checked 12 Oct 2026 · Back to text ↑
3. 3
   Massachusetts Department of Public Health, Apply for an Adult Day Health program license Checked 12 Oct 2026 · Back to text ↑
4. 4
   Massachusetts Department of Public Health, Adult Day Health Application Checklist Checked 12 Oct 2026 · Back to text ↑
5. 5
   Massachusetts Department of Public Health, Suitability Form (Initial Licensure/Suitability/Notice of Intent to Acquire) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Massachusetts Department of Public Health, Adult Day Health Program Capacity Form Checked 12 Oct 2026 · Back to text ↑
7. 7
   Massachusetts Department of Public Health, Adult Day Health Clinical Information and Attestation Form Checked 12 Oct 2026 · Back to text ↑
8. 8
   Massachusetts Department of Public Health, Local Fire Certificate Checked 12 Oct 2026 · Back to text ↑
9. 9
   Massachusetts Department of Public Health, Circular Letter DHCQ 15-4-633: Additional Information Regarding ADH Licensure (April 16, 2015) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Massachusetts Department of Public Health, Health care facility licensure fee schedule Checked 12 Oct 2026 · Back to text ↑
11. 11
    MassHealth, 130 CMR 404.000: Adult Day Health Services Checked 12 Oct 2026 · Back to text ↑
12. 12
    MassHealth, 130 CMR 404.000: Adult Day Health Services (regulation page, with link to related rate regulations) Checked 12 Oct 2026 · Back to text ↑

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