Montana adult day care center license: DPHHS rules, application packet and inspections

Who needs the license, and which Montana license you actually want

Montana law defines an adult day-care center as a facility, either freestanding or connected to another health care facility, that gives adults the care they need for daily living on a regularly scheduled basis and does not provide overnight care ⁠¹. The definition sets no minimum number of clients and no minimum age beyond “adults” ⁠¹. Because the definition turns on the service and not on headcount, if you run a scheduled daytime program that helps adults with daily living, you need this license.

In the statute, an adult day-care center counts as a “residential care facility”, alongside adult foster care homes, assisted living facilities and retirement homes ⁠¹. Residential care facilities fall under the definition of “health care facility” ⁠¹, and no one may run a health care facility without a DPHHS license ⁠². That is why this license comes from the Office of Inspector General’s Licensure Bureau, the office that licenses assisted living and home health. It does not come from the child care licensing office.

The neighboring licenses are easy to confuse:

• Adult foster care home. This is a private home or other facility giving only light personal or custodial care to four or fewer unrelated disabled or aged adults ⁠¹. It is a living arrangement, while adult day care may never include an overnight stay ⁠⁴. See the Montana adult foster care home guide.
• Assisted living facility. This is a group residence with personal care and 24-hour supervision, licensed in categories A through D. See the Montana assisted living facility guide.
• Home health agency. This license covers care delivered where clients live, and it must include a licensed registered nurse plus at least one other therapeutic service ⁠¹. See the Montana home health agency guide.

A center may operate on the premises of another licensed health care facility, such as a nursing home or assisted living facility. In that case the host facility may give day clients any service it is licensed for, but never overnight service. Both facilities must have enough space and staff, and the center must name in writing the people responsible for its program ⁠⁴. If you are an existing provider adding a day program, you still need a separate adult day care license, but you can reuse much of your existing infrastructure. Rules for this business type in other states are compared on the adult day care license page.

What the rules expect the program to do

Montana’s adult-day rule is short. The service standard is mostly in ARM 37.106.2602 ⁠⁴:

• Help with activities of daily living, including eating, walking and grooming ⁠⁴.
• Recreational and social activities, with a calendar posted where clients can see it. Keep each calendar for at least one year after its last event ⁠⁴.
• A rest area with a bed or lounge chair, blankets and pillows. If you provide beds, each one needs clean linen, a spare linen supply and a moisture-proof mattress or mattress cover with a pad ⁠⁴.
• Telephone access for every client ⁠⁴.
• A way to identify clients’ belongings, safekeeping for valuables, and an accounting of any personal funds you handle ⁠⁴.
• A client who can walk only with mechanical help, such as a walker or wheelchair, may only be kept on the ground floor ⁠⁴. In a two-story building, this affects where you put your program space.

Every client, or the client’s legal representative, signs a written agreement. It must cover the cost of care, the type of care, the services provided, and how the responsible party will be told about significant changes in the client’s condition and any need for emergency care ⁠⁴. The Licensure Bureau reviews and approves this agreement before licensing ⁠⁶. If a client is removed from the center, you must notify the legal representative promptly and record the date and the person contacted ⁠⁴.

Medications: assistance only

A client who takes medication at the center must be able to take it on their own. Staff may only remind the client, take the container out of storage, help remove the cap, guide the client’s hand and watch the client take it ⁠⁴. All medications stay in locked storage until the client leaves. You keep a medication administration record showing every dose taken and every dose refused or missed ⁠⁴. Montana’s adult-day rule has no provision for nurse-administered medications. If your target clients need that, check the licensed services of a host facility or the home health license.

Meals

Meal requirements depend on how long a client stays: at least one meal for stays of up to 10 hours, two meals for stays over 10 hours, and three meals per 16-hour period. Snacks must be offered between meals ⁠⁴. Other food rules:

• Home-canned food is banned ⁠⁴.
• Cold potentially hazardous food is held at 41°F or below and hot food at 140°F or above. Freezers run at 0°F or below ⁠⁴.
• Food is stored at least six inches off the floor ⁠⁴.
• Food is cut, chopped or ground to suit each client ⁠⁴.
• If a caterer or another establishment prepares your meals, keep each contract on file for at least one year ⁠⁴.

Administrator and staffing

Every center must employ an administrator. The rule sets character and competence standards but no degree, license or experience requirement. The administrator must be in good physical and mental health, be of reputable and responsible moral character, show concern for clients’ safety, be responsible for the center at all times, and know and follow the adult day care laws and rules ⁠⁴. An owner who meets these standards may serve as administrator ⁠⁴. Before licensing, the prospective administrator signs an attestation that they have reviewed the adult day care rules ⁠⁶.

The administrator’s duties are listed in the rule ⁠⁴:

• Oversee services, record keeping, and hiring, training and supervision of staff.
• Keep the current license posted where the public can see it.
• Review every accident or incident that injures a client or employee, take corrective action, and keep a record of both.
• Comply with the Montana Vulnerable Adult Prevention of Abuse Act (MCA 52-3-801 and following).
• Keep a personnel record for every employee, including substitutes, for at least one year after they leave.
• Keep a client census documenting attendance, covering at least the past 12 months.

Staffing. Montana sets no client-to-staff ratio for adult day care. The rule requires at least one employee present whenever any client is on site, and enough staff at all times for “the number and characteristics of its clients” ⁠⁴. Volunteers may help, but they cannot replace employees in your staffing plan, and volunteers doing staff duties need their own orientation and training files ⁠⁵. Daily work schedules showing who was on duty must be kept for one year, and the person in charge of each shift must carry keys to all doors ⁠⁴.

Orientation. Every employee receives documented orientation covering the following ⁠⁴:

• the policies and procedures manual and how to use it
• their job description
• the center’s services
• simulated fire, evacuation and disaster drills
• spotting and fixing safety hazards
• emergency procedures such as basic first aid

The minimum standards for all facilities add an employee file containing a job description and orientation record signed by the employee, plus copies of any required credentials. Files must be produced within 24 hours if kept off site ⁠⁵.

Background checks. Montana’s statutory employee background-check mandate is written for assisted living facilities ⁠¹¹. The adult day care rules contain no equivalent requirement. The application letter ⁠⁶ and the bureau’s adult day care page ⁠⁷ list no background-check step, and the adult-day rules and minimum standards ⁠⁴⁠⁵ set no check for adult day care staff. Ask the Licensure Bureau at 406-444-2676 whether it expects one, and screen against the Vulnerable Adult Prevention of Abuse Act duties the administrator must follow ⁠⁴.

Building, fire and local sign-offs

Several authorities have to approve the building before the Licensure Bureau will license it:

• Local building and fire codes. Any construction, alteration, addition or renovation must meet local building and fire codes. It must be approved by the local code official and by the State Fire Marshal or a designee ⁠⁴. The application packet asks for local building code approval and, for new construction, the certificate of occupancy ⁠⁶.
• Health care construction standards. The minimum standards adopt three references for construction of all health care facilities: the 2018 AIA/FGI Guidelines for Design and Construction of Hospitals and Health Care Facilities, the 2012 NFPA 101 Life Safety Code Handbook, and the 2009 ANSI A117.1 accessibility standard ⁠⁵. Where these conflict with the adult day rules, subchapter 26 controls ⁠⁴.
• Plan review for new construction or alterations. By statute, you must submit plans and specifications for approval before construction starts ⁠². For new construction, additions and alterations, the rule requires schematic plans and bid-ready drawings, all stamped by an engineer or architect licensed in Montana. An approval expires after one year, with one six-month extension available ⁠⁵. For every applicant, including existing buildings, the packet requires a BFS Plan Submittal Form sent to the bureau’s construction consultant ⁠⁶.
• Fire inspection. Ask the State Fire Marshal’s office who covers your area and submit the fire inspection report. If exit doors will be locked, only single-motion locks are approved ⁠⁶. After opening, the center needs an annual fire inspection by local authorities, and you keep the record for one year ⁠⁴.
• Water and sewer. On a well, submit a certified lab report on drinking-water safety dated within the past year. On septic, submit the county health department’s inspection, and it must reflect the building’s number of bedrooms, not its number of clients ⁠⁶. The adult-day rule adopts the state water-supply and sewage system rules (ARM 37.111.110 and 37.111.116) ⁠⁴.
• Door alarms or wander systems. If an electronic security system will monitor or restrict client movement, submit written confirmation from the installer that it is installed and working as designed ⁠⁶.

Inside the building, these physical standards apply:

• Lighting: at least 10 foot-candles in all rooms and hallways, 30 for reading lamps and toilet and bathing areas, 50 in food preparation areas, and at least 5 at floor level in hallways at all times ⁠⁴.
• Water and cleaning: hot water at sinks and bathing fixtures may not exceed 120°F. Cleaners for toilets, sinks, showers and floors must be EPA-registered germicides or fungicides ⁠⁴.
• Floors: carpet is banned in bathrooms, kitchens, laundries and janitor closets ⁠⁴.
• Sinks: every sink needs soap, individual towels and a nearby waste receptacle ⁠⁴.
• Laundry: if a freestanding center does laundry on site, it needs a dedicated laundry area with a washer and an outside-vented dryer. That area needs handwashing facilities and washer water of at least 110°F. No laundry may be done in food preparation or dishwashing areas ⁠⁴.

The floor plan you submit may be hand-drawn if it shows dimensions. The bureau measures rooms from the front of built-ins such as closets and excludes door-swing areas ⁠⁶. The adult-day rule sets no square-footage-per-client figure. Floor-plan and space requirements are checked against the minimum standards ⁠⁶⁠⁵.

Plans and policies the bureau reviews before opening

The policies and procedures manual must cover every service you provide, confidentiality and protection of client records, infection control, and a disaster and fire plan ⁠⁴. A center inside another licensed facility may cross-reference the host’s policies. It must still have its own policies on how services are integrated between the two facilities ⁠⁴. All facilities must review the manual at least every other year and document the review ⁠⁵. All facilities must also have policies protecting medical practitioners’ conscience and whistleblower rights ⁠⁵.

• Infection control. An employee with a communicable disease that can spread through food handling or personal care stays home until it can no longer be transmitted. The administrator decides when the employee may return. If a client is suspected of having a dangerous communicable disease, the administrator contacts the client’s physician and takes protective measures ⁠⁴. The minimum standards add an infection prevention program reviewed at least once a year ⁠⁵.

• Disaster plan. Adult day care facilities need a written plan for two scenarios ⁠⁵:

  • sheltering in place, with extra blankets, water and food
  • evacuating clients to at least one named off-site evacuation point, backed by a written agreement that is updated every year

  Review the plan with all staff every year and keep the documentation for three years ⁠⁵. Fire drills are required at all health care facilities ⁠⁵.

• Maintenance. Keep a written maintenance program, and provide housekeeping daily or as needed ⁠⁴.

The application, in order

The Licensure Bureau’s letter to prospective providers sets the sequence ⁠⁶. Initial and change-of-ownership applications are filed through the bureau’s online licensing portal, linked from the adult day care page. Renewals go through the portal’s provider login ⁠⁷.

1. Time the application

   Do not file earlier than six months before the date you want to be licensed. Applications that stall without provider activity are withdrawn under bureau policy ⁠⁶.

2. File the license application and fee in the portal

   The administrator or a designee signs the application ⁠⁵⁠⁷.

3. Send the construction documents

   Submit the floor plan with room dimensions, the BFS Plan Submittal Form for the construction consultant, local building approval or certificate of occupancy, and any water, septic and security-system documents ⁠⁶.

4. Submit policies, procedures and the client agreement

   These must arrive at least 45 days before your planned opening date, for review and approval ⁠⁶.

5. Get the fire inspection and file the administrator’s attestation

   Both go into the file ⁠⁶.

6. Schedule the physical compliance inspection

   The bureau’s construction consultant inspects on site. All documents must be approved, and the consultant must sign off, before a license can issue ⁠⁶. Under the statute, the initial inspection takes place within 45 days after the department receives a new application and notice that the facility is ready ⁠³.

7. Open on a six-month provisional license

   After final approval the bureau issues a six-month provisional license. You may not admit clients before that point ⁠⁶.

8. Pass the licensure survey

   A Licensure Bureau surveyor makes an on-site survey within the provisional period to check compliance with the adult day care rules ⁠⁶. The bureau publishes the survey tools it uses, one for adult day care and one for the minimum standards. Working through them before the visit is the most direct preparation available ⁠⁷.

Fees

The application letter lists a fee with the application ⁠⁶. The only fee-setting authority in the statutes reviewed is in the assisted living licensing section, which lets DPHHS set license and inspection fees by rule for those facilities ⁠¹². The adult day care fee amount does not appear on the bureau’s adult day care page, in the application letter, or in the adult-day or minimum-standards rules as published on October 12, 2026 ⁠⁷⁠⁶⁠⁴⁠⁵. No official source reviewed states the amount. Ask the Licensure Bureau at 406-444-2676 for the adult day care fee before budgeting ⁠⁶.

License terms, renewal and inspections

A license is valid only for the person and premises named on it. It cannot be sold, assigned or transferred. If you close or sell, you return or destroy it ⁠². A new owner files a change-of-ownership application through the same portal as a new applicant ⁠⁷.

After the provisional period, license length depends on survey results ⁠⁵:

• One year: for a facility in operation less than one year, after a change of ownership, or after deficiencies in the prior 12 months that threatened health, safety or welfare.
• Two years: with only minor deficiencies.
• Three years: after a deficiency-free survey, or with accreditation by a CMS-approved accrediting body.

Once a renewal application is received, the department inspects the center without prior notice before the current license expires ⁠³. Inspectors may enter the licensed premises and review all records at any reasonable time ⁠⁵. If standards are not met, the department may reduce a license to a provisional license of less than one year ⁠³.

Records the surveyor will ask for:

• client records, which must include identification, physician contact, medications, physician visits and the medication administration record ⁠⁴
• personnel files, census data, work schedules and activity calendars ⁠⁴
• incident reports ⁠⁴
• fire inspection records ⁠⁴
• three years of disaster-plan review documentation ⁠⁵

Under ARM 37.106.2620 you keep client records at least five years after the last day of service or the client’s death, whichever comes first ⁠⁴. The minimum standards for all facilities say six years ⁠⁵. ARM 37.106.2601 says subchapter 26 controls over the general standards when they conflict ⁠⁴, but neither source says which period the bureau applies at survey. Keeping records six years satisfies both; ask the bureau which it enforces.

How Montana adult day centers get paid by Medicaid

Montana Medicaid pays for adult day services as Adult Day Health under the Big Sky Waiver, a home and community-based services waiver. The waiver’s policy manual describes the service as health, nutritional, recreational and social services outside the person’s home, with no overnight stay. Providers must hold a DPHHS license ⁠⁹, so the adult day care center license comes first.

The manual, dated August 1, 2011, also says the following ⁠⁹:

• The center provides at least one meal a day to members staying over 10 hours.
• Transportation costs may be built into the provider’s rate.
• The waiver case management team checks the center’s written client agreement before approving admission, to avoid paying twice for the same service.

All Big Sky Waiver providers enroll electronically through the Montana Medicaid MATH web portal, using the Home and Community Based Services provider type ⁠¹⁰. Rates were not reviewed for this guide.

Recent changes

DPHHS revised the adult day care rules under MAR Notice 37-1099, effective January 11, 2025. The notice amended ARM 37.106.2602 (services, administration and staffing), 2603 (policies), 2606 (construction), 2609 (infection control), 2616 (food service), 2620 (records) and 2621 (medications). It repealed ARM 37.106.2608, the adult-day disaster and fire plan rule ⁠⁸. Disaster planning now runs through the policy manual’s required disaster and fire plan, which must meet the all-facility standard in ARM 37.106.322 ⁠⁴⁠⁵. Packet material written before 2025 may cite the old rule.

The bureau’s printable rule file shows a “REP” history line under ARM 37.106.2609 (infection control), but the adoption notice lists that rule as amended, not repealed ⁠⁸. Treat the infection-control rule as in force.

Sources

1. 1
   Montana Legislature, Montana Code Annotated 50-5-101: Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   Montana Legislature, Montana Code Annotated 50-5-201: License requirements Checked 12 Oct 2026 · Back to text ↑
3. 3
   Montana Legislature, Montana Code Annotated 50-5-204: Issuance and renewal of licenses, inspections Checked 12 Oct 2026 · Back to text ↑
4. 4
   Montana Department of Public Health and Human Services, ARM 37.106 subchapter 26: Adult Day Care (printable version) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Montana Department of Public Health and Human Services, ARM 37.106 subchapter 3: Minimum Standards for All Health Care Facilities (printable version) Checked 12 Oct 2026 · Back to text ↑
6. 6
   DPHHS Office of Inspector General, Licensure Bureau, Letter to Prospective Adult Day Care Providers (application letter) Checked 12 Oct 2026 · Back to text ↑
7. 7
   DPHHS Office of Inspector General, Licensure Bureau, Adult Day Care Center Checked 12 Oct 2026 · Back to text ↑
8. 8
   Montana Department of Public Health and Human Services, MAR Notice No. 37-1099: Notice of adoption, adult day care facilities (effective January 11, 2025) Checked 12 Oct 2026 · Back to text ↑
9. 9
   DPHHS Senior and Long Term Care Division, HCBS Waiver Policy Manual 703: Adult Day Health Checked 12 Oct 2026 · Back to text ↑
10. 10
    DPHHS Senior and Long Term Care Division, HCBS Waiver Policy Manual 603: Provider enrollment Checked 12 Oct 2026 · Back to text ↑
11. 11
    Montana Legislature, Montana Code Annotated 50-5-225: Assisted living facilities, employee background checks Checked 12 Oct 2026 · Back to text ↑
12. 12
    Montana Legislature, Montana Code Annotated 50-5-227: Licensing assisted living facilities Checked 12 Oct 2026 · Back to text ↑

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