Opening a medical adult day center in New Jersey: the DOH adult day health services license

Medical day care is the licensed product in New Jersey

New Jersey licenses adult day care as a health care facility. The Department of Health (DOH) describes adult day care services as “preventive, diagnostic, therapeutic, and rehabilitative services under medical and nursing supervision for functionally impaired adult participants,” provided for no more than 12 hours a day ⁠¹. The rule text adds that participants must not be related to the members of the governing authority by marriage, blood or adoption, and that the 12-hour limit applies per calendar day ⁠². People in the industry usually call these centers “medical day care” or “adult medical day care,” and DOH’s survey forms use that name ⁠⁷.

The licensing rule is N.J.A.C. 8:43F, Standards for Licensure of Adult Day Health Services Facilities. It applies “to all facilities that provide adult day health services, regardless of the source of payment” ⁠². So a center that takes only private-pay participants needs the same license as one that bills Medicaid. Medicaid payment rules are in a separate chapter, N.J.A.C. 10:164, run by the Department of Human Services. That chapter replaced the old N.J.A.C. 8:86 ⁠²⁠¹⁰.

DOH readopted 8:43F effective November 18, 2021, and published technical changes on December 20, 2021. The chapter now expires on November 18, 2028 ⁠². The 2021 notice only updated agency names, addresses and cross-references. It did not rewrite the substantive standards ⁠².

Social adult day programs and other neighbors

A program that offers only social activities, meals and supervision, with no nursing or therapy, is not on DOH’s list of licensed facility types ⁠¹. The 2014 federal regulatory review of adult day services says New Jersey’s social adult day centers “do not have to be licensed but must meet all local building code requirements.” It also says their principal public funding was Social Services Block Grants passed to county Area Agencies on Aging, and that the state’s Assistance for Community Caregiving program (a non-Medicaid program) also supports them ⁠⁹. That review is twelve years old. No current state page confirming or changing that statement was found, so ask the Division of Aging Services and your municipality whether a social-only program needs any registration or local approval before you open.

The line between the two models matters. In 2025 DOH ordered an operator in Little Ferry that held no license to cease and desist “providing all services and advertisements,” after it found the operator advertising health care services on its website without a license. Surveyors later saw staff in scrubs taking blood pressures at an off-site location. DOH then issued an information order under N.J.A.C. 8:43E-3.4(a)11, which allows a $250 penalty, after notice and a chance to cure, for each day a facility fails to report required information ⁠¹³. The order does not say which single activity triggers the license. If your program will take vital signs, give medications or advertise health services, ask the Division in writing whether you need the 8:43F license before you open.

Other New Jersey licenses that founders confuse with this one:

• Residential care, where people live on site, falls under the assisted living residence license. A small home for up to three adults is covered by the adult family care caregiver license.
• Care in clients’ own homes is either a health care service firm registration with the Division of Consumer Affairs, for companion and personal care, or a home health agency license from DOH, for skilled care. Neither is covered by this guide.
• An HIV adult day health services facility is licensed under the ambulatory care rules, N.J.A.C. 8:43A, not 8:43F ⁠¹⁰.

Check the moratorium history before you sign a lease

New Jersey has frozen new adult day health licenses before. The history notes to N.J.A.C. 10:164 list a series of public notices titled “Moratorium Affecting Licensure of Adult Day Health Care Facilities and Services” at 40 N.J.R. 6487(d), 41 N.J.R. 4328(b) and 42 N.J.R. 2644(b). The last one listed is “Extending Moratorium Affecting Licensure of Adult Day Health Services Facilities” at 43 N.J.R. 3044(a) ⁠¹⁰. DOH’s rules page still lists the 41 N.J.R. 4328(b) moratorium notice under public notices ⁠¹¹.

Two things suggest new applications are being processed today. DOH lists the CN-6 new-facility project application as last updated January 31, 2024 ⁠⁶. The 10:164 history, which runs through the June 16, 2025 New Jersey Register, lists no moratorium notice after 43 N.J.R. 3044(a) ⁠¹⁰. Still, no official notice ending the moratorium was found. Before you sign a lease, ask the Certificate of Need and Healthcare Facility Licensure program at the number below whether it is accepting new CN-6 applications and whether any moratorium or need limit applies to your county. The program’s published phone number is (609) 633-9042 ⁠⁴.

Adult day health does not appear in DOH’s table of projects that need full or expedited certificate of need review. That table does list long-term care, new assisted living and home health ⁠¹². Adult day health goes through a licensure project application instead, handled by the same office ⁠⁴.

Who can own and run the facility

Criminal background clearance. DOH will not issue or continue a license unless the current or prospective owners and administrators have prior clearance from its Criminal Background Investigation Unit (CBIU) ⁠². Clearance is refused to anyone convicted of a crime that relates adversely to the ability to provide care. The rule lists homicide, assault, kidnapping, sexual offenses, robbery, crimes against the family, children or persons adjudicated incapacitated, and financial crimes. The exception is a person who shows rehabilitation under the Rehabilitated Convicted Offender Act, N.J.S.A. 2A:168A-1 et seq. A disqualified person may challenge the accuracy of the criminal record before being permanently disqualified ⁠². The CN-6 repeats that clearance is required before DOH approves the owner’s licensure application and before the administrator operates the facility ⁠⁴.

Track record. Approval of a project proposal depends on a review of the applicant’s track record under N.J.A.C. 8:43E-5.1(b). Applicants must show that the premises, equipment, personnel (including principals and management), finances, rules and bylaws, and standards of health care are “fit and adequate” ⁠³. The 2021 readoption left this paragraph unchanged ⁠². No facility may be owned or operated by someone with a history of continuing or serious violations of 8:43F, 10:164 or other statutory requirements ⁠².

Ownership disclosure. The CN-6 asks you to identify 100% of the ownership, including names and home addresses of every principal owning 10% or more. For a nonprofit, you list the board members. Each listed person must sign an attestation that they have read N.J.A.C. 8:43F and will comply with it. You must also list any interest each person holds in a licensed health care facility in New Jersey or another state. For out-of-state facilities, attach letters from those states’ regulators about the facilities’ track records ⁠⁴.

Staffing the center

DOH’s initial-survey checklist asks for résumés and checks qualifications for each key position. These are the administrator (8:43F-3.2) and a designated alternate (3.1(a)); the director of nursing (7.2) and an alternate (7.1(a)); the social worker (12.1); the activities director (13.2); the dietitian (10.3); a medical records consultant (15.2); the food service supervisor (10.2); and an infection control designee (16.1(b)) ⁠⁷. The administrator affidavit DOH uses (form AAS-40) covers the same standards, plus 6.2, “Description of Staffing Capabilities” ⁠⁸.

The 2014 federal review summarizes the rule’s staffing core as follows ⁠⁹:

• The facility must have at least an administrator/director, a registered professional nurse, a social worker and an activities director. It must also designate a physician as medical consultant, and a pharmaceutical consultant who is not the pharmacy provider and has no affiliation with it.
• If the food service supervisor is not a dietitian, a consultant dietitian must review dietary services on a regular schedule.
• A full-time administrator must be on the premises whenever participant care is provided, with an alternate designated in writing.
• The director of nursing must be an RN who does not hold any other position while serving as director of nursing. That director, or another designated RN, must be on duty whenever the facility is operating.
• At least one full-time or full-time-equivalent direct care staff member is required for every nine participants. Additional licensed professional staff are required where daily attendance exceeds 60.

The 1:9 ratio and the 60-participant threshold come from the federal summary, and the current section text of 8:43F-6 could not be read from an official source for this guide. Ask the Division which staffing ratio it applies to your planned census, including any extra staff required by participant acuity.

Some qualifications appear in the 2021 rule text itself. The dietitian must be registered, or eligible for registration, with the Commission on Dietetic Registration ⁠². One route to qualifying as activities director is certification, or eligibility for it, as an Activity Director Certified (ADC) or a Certified Therapeutic Recreation Specialist (CTRS). Another is a high school diploma, three years of full-time activities experience in a licensed health care facility, and a 90-hour activities education program approved by DOH ⁠².

All direct-care staff must be screened for criminal convictions that relate adversely to their ability to provide care, with the same rehabilitation exception ⁠². The survey checklist also looks for these items ⁠⁷:

• Staff orientation on hire, and annually after that, covering elder abuse, participant rights, infection control, emergency plans and pain management.
• A two-step Mantoux test on hire and a one-step test each year.
• At least one CPR-certified staff member on duty at all times.

The building

Plan review. Any proposed facility with a construction program must send plans to the Health Care Plan Review Unit of the Department of Community Affairs (DCA), Division of Codes and Standards, before construction starts. The licensure application for a new, renovated or expanded facility must include DCA’s written approval of final construction ⁠². A new, renovated or expanded facility may not be occupied without DCA’s final approval letter ⁠³. The CN-6 requires scaled architectural floor plans “regardless of whether renovation/construction is required.” All rooms must be labeled with dimensions and proposed use ⁠⁴. Surveyors ask to see the certificate of occupancy at the initial survey ⁠⁷.

Space items surveyors check. The initial-survey form lists these physical-plant items under subchapter 14 ⁠⁷:

Emergency readiness. You need oxygen, suction, airway and an Ambu bag on hand. You also need written emergency procedures, a posted evacuation diagram, emergency drills four times a year, and fire extinguishers inspected and labeled every year ⁠⁷.

Applying: the real order of steps

1. File the CN-6 project application

   Mail it to the Assistant Director, Certificate of Need and Healthcare Facility Licensure, PO Box 358, Trenton, NJ 08625-0358, or send it by courier to 120 South Stockton Street, 3rd Floor, Trenton, NJ 08608-1832. The package is a cover letter, two copies of the project narrative, the fee and architectural plans ⁠⁴. The form asks for the number of slots, your days and hours of operation, the number of sessions, and whether occupational, physical and speech therapy, laundry and meal preparation will be on site or off site ⁠⁴.

2. Wait for written approval

   DOH needs at least 60 days to review the application, and incomplete applications delay it. “You are not authorized to implement any portion of your proposal until you receive written approval” ⁠⁴. The approved proposal must say whether you will run more than one shift and give the hours for each shift. Later changes in hours must be reported in writing ⁠².

3. Get CBIU clearance

   for every owner and the administrator ⁠²⁠⁴.

4. Get DCA plan approval and build

   Plans go to DCA before construction, and you need DCA’s final approval before occupancy ⁠²⁠³.

5. Hold the preliminary conference

   When construction is about 80% complete, or opening is within 30 days, schedule a preliminary conference with the Division to review the conditions for licensure and operation ⁠².

6. Submit the licensure application and pass the survey

   Once the application is approved and the building is ready, DOH surveys at its discretion. It notifies you of any deficiencies in writing and resurveys after you report corrections ⁠²⁠³. Professional staff must already be employed to the rule’s staffing levels at that point ⁠³. Have on site the certificate of occupancy, key staff résumés, a list of licensed staff, the policy and procedure manual, personnel and health files, contracts, the participant register and the staffing schedule ⁠⁷.

7. Receive the license, then admit participants

   “No facility shall admit participants to the facility until the Division issues a license” ⁠².

The policy manual must include procedures for reporting abuse, elopement, communicable disease, poisonings and unexplained deaths. Suspected abuse during the program is reported to the Long-Term Care Ombudsman if the participant is 60 or older, and to DOH’s Division of Health Facility Survey and Field Operations if the participant is younger. Abuse that staff discover happening outside the program is reported to Adult Protective Services for participants aged 60 or older ⁠². Reportable events go to DOH by phone at (609) 633-8991 or (800) 792-9770, with written confirmation within 72 hours ⁠².

Fees

As published on October 12, 2026, these fees are set by N.J.A.C. 8:43F-2.1(a) and the DOH project forms. All are non-refundable ⁠³⁠⁴⁠⁵:

For a 60-slot center, the CN-6 formula gives $1,500 + $600 = $2,100. Government agencies are exempt from the project application fee. Checks are payable to “Treasurer, State of New Jersey” ⁠⁴. The renewal, reduction, relocation, transfer and inspection amounts come from the official 2006 text of the rule. The 2021 notice shows no change to those paragraphs ⁠²⁠³, and the CN-6 and CN-8 (January 2024) still print the $1,500 + $10 per slot formula ⁠⁴⁠⁵. Confirm the renewal, relocation and inspection amounts with the Division when you file.

Daily operations the rule fixes

• Hours. Services must run for at least five consecutive hours and no more than 12 hours a day, not counting transportation time, at least five days a week ⁠².
• Admission. Each participant needs a signed history and physical done within 60 days before admission or on admission ⁠². According to the federal summary, participants must be at least 16. A facility may not admit people whose only problem is substance abuse, or people whose behavior endangers themselves or others ⁠⁹.
• Care plans and records. Care plans list treatment orders, goals and scheduled attendance days, and are reassessed quarterly. Records include a home environment assessment, a current photo and a daily attendance record. Menus are planned 14 days ahead ⁠⁷.
• Transportation and quality. The rule has subchapters on transportation (17) and quality improvement (18). DOH’s affidavit lists a written plan for security and accountability during transport, and the policy on restraints ⁠⁸.

Getting paid: Medicaid, JACC and the per diem

To bill Medicaid, HCEP or JACC, a center must hold the 8:43F license. It must also file the Medicaid Provider Application (PE-1), the Participation Agreement (PE-5) and a written narrative statement on the proposed facility, and be approved as a Medicaid provider. Serving JACC participants requires separate JACC provider approval ⁠¹⁰.

Who qualifies. Each participant needs prior authorization, based on an assessment with a state-prescribed tool. The participant must need at least one of the following ⁠¹⁰:

• Limited assistance with two or more activities of daily living, all provided on site.
• One skilled service provided on site every day.
• Time-limited rehabilitation ordered by a physician, physician assistant or advanced practice nurse.
• Supervision or cueing in three activities of daily living, together with specific short-term memory and decision-making deficits.

Eligibility is reassessed at least once a year. People living in a residential health care facility, people receiving 24-hour inpatient care, and people whose day care would duplicate another Medicaid service they have chosen are ineligible ⁠¹⁰. A facility may be authorized to have its own RN do these assessments. If so, the initial assessment includes a home visit ⁠¹⁰.

What you must deliver. For each beneficiary you must provide at least five hours of service a day, not counting transportation, up to five days a week. You must also provide transportation between the participant’s home and the center ⁠¹⁰.

How the rate is set. The per diem depends on the facility type ⁠¹⁰:

• Nursing-facility-based programs get 45% of that nursing facility’s per diem.
• Freestanding centers get the average of nursing-facility-based adult day rates in effect on July 1 each year.
• Hospital-affiliated programs negotiate a rate capped at the nursing-facility-based maximum.

Physical, occupational and speech therapy are billed separately. The Medicaid rate may not exceed what you charge private-pay participants. You must prepare an annual cost report, signed by the administrator or an officer of the facility, and a financial statement signed by a CPA ⁠¹⁰.

Inspections, renewal and changes

Licenses run for one year or less and are renewed each year on the anniversary of the original license. Inspections are tied to renewal ⁠⁹. DOH may make survey visits at any time and may ask for a plan of correction ⁠³. Administrators sign an affidavit (AAS-40) stating the facility is in substantial compliance with listed mandatory standards. The form warns that “a willfully false statement could result in enforcement penalties” ⁠⁸.

Several changes need DOH action:

• Adding slots. File a CN-8 with the same $1,500 + $10 per slot fee ⁠⁵.
• Changing hours. Report changes in hours of operation in writing ⁠².
• Selling the facility. Report a change of ownership in writing at least 30 days before it happens. The buyer files its own application and receives licensure forms after approval ⁠².
• Closing. Give participants, their practitioners and payers 30 days’ notice before you surrender the license. Return the license within seven working days ⁠².
• Waivers. Request a waiver of a specific rule in writing from the Division Director ⁠².

What changed recently and what is pending

• DOH updated the CN-6 and CN-8 forms on January 31, 2024. They replaced the older HFEL-3 and HFEL-4 forms ⁠⁶.
• The 2021 readoption moved Medicaid cross-references from N.J.A.C. 8:86 to 10:164 and renamed the licensing office the Division of Certificate of Need and Licensing ⁠². Licensing mail goes to PO Box 358, Trenton ⁠²⁠⁴.
• N.J.A.C. 8:43F expires on November 18, 2028 unless readopted. Watch the New Jersey Register for a proposal before then ⁠².
• The status of the adult day health licensure moratorium could not be confirmed (see above).

Sources

1. 1
   New Jersey Department of Health, Facility Types Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Jersey Department of Health, Notice of Readoption with Technical Changes, N.J.A.C. 8:43F, Standards for Licensure of Adult Day Health Services Facilities (53 N.J.R. 12(2), December 20, 2021) Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Jersey State Library (New Jersey Administrative Code archive), N.J.A.C. 8:43F, Standards for Licensure of Adult and Pediatric Day Health Services Facilities (Supplement 1-17-06) Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Jersey Department of Health, CN-6, Project Application for an Adult Day Health Services Facility (January 2024) Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Jersey Department of Health, CN-8, Project Application for Expansion Slots at a Licensed Adult Day Health Services Facility (January 2024) Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Jersey Department of Health, Health Facilities Forms Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Jersey Department of Health, AAS-22, Adult Medical Day Care Inspection Information: Requirements for Initial Survey Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Jersey Department of Health, AAS-40, Affidavit of Compliance with New Jersey Licensure Standards for Adult Day Health Care Facilities Checked 12 Oct 2026 · Back to text ↑
9. 9
   U.S. Department of Health and Human Services, ASPE, Regulatory Review of Adult Day Services: Final Report, 2014 Edition, New Jersey profile Checked 12 Oct 2026 · Back to text ↑
10. 10
    New Jersey Department of Human Services, N.J.A.C. 10:164, Adult Day Health Services (through 57 N.J.R. 12, June 16, 2025) Checked 12 Oct 2026 · Back to text ↑
11. 11
    New Jersey Department of Health, Health Facilities Rules and Regulations Checked 12 Oct 2026 · Back to text ↑
12. 12
    New Jersey Department of Health, Certificate of Need and Facility Licensing Checked 12 Oct 2026 · Back to text ↑
13. 13
    New Jersey Department of Health, In re: Licensure Violation, Information Requirement Order (June 26, 2025) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF