Rhode Island adult day care program license: RIDOH rules, staffing and the no-fee application

Who needs the license

R.I. Gen. Laws § 23-1-52 directs the Director of Health to license “adult daycare programs.” The statute defines one as “a comprehensive, nonresidential program designed to address the biological, psychological, and social needs of adults through individual plans of care” that offers health, social and support services “in a protective setting” ⁠¹. The rule, 216-RICR-40-10-7, uses the same definition. It applies to every program that serves “the elderly who are in need of supportive care and supervision during the daytime,” and it defines elderly as 55 or older ⁠².

Neither the statute nor the rule sets a minimum number of participants. What decides whether you need the license is the model: individual care plans and a protective setting. The rule has three hard edges:

• No one may operate without a license. No person, alone or jointly with anyone else, may “establish, conduct or maintain an adult day care program” without one ⁠².
• The name is protected. You may not use “adult day care program” or any similar term in your title, advertising or other communications unless you hold the license ⁠².
• Age mix. Participants must be at least 18, and at least 51% of your average daily attendance must be 55 or older ⁠².

The license covers only the premises and the persons named in the application. You cannot transfer or assign it without RIDOH’s written approval, and you must post it in a conspicuous place ⁠².

Licenses people confuse with this one

All adult care licenses in Rhode Island come from RIDOH, but they cover different settings:

• Overnight care for 6 or more adults (lodging, meals and personal assistance) needs an assisted living residence license.
• Homes for 2 to 5 unrelated adults are adult supportive care homes. The statute lets only certain existing providers run them, and “a licensed adult day services provider” is on that list ⁠⁷. Once you hold an adult day license, that becomes a possible expansion path. See the adult supportive care home guide.
• Care in the client’s own home falls under RIDOH’s home care provider or home nursing care provider licenses, governed by 216-RICR-40-10-17. Until June 12, 2026, establishing a home care provider needed a letter of intent, Health Services Council review and the Director’s written approval of a certificate of need ⁠⁸; P.L. 2026, ch. 84, Article 12 removed home care providers from the certificate-of-need statute on that date ⁠⁹, but RIDOH’s rule and page still describe the step (see the home care provider guide). The adult day license has no certificate of need step in the rule or on the application form ⁠²⁠⁴.

What it costs and how long the license lasts

The RIDOH fee rule lists the “Adult Day Care Program: Biennial License” as No Fee (fee rule version effective March 25, 2026) ⁠⁵. The application form also says “There is no fee for this application” ⁠⁴. Your costs come from the building, the local approvals and the food license, not from RIDOH’s licensing fee.

Every license expires on March 31 of each odd-numbered year, whenever it was issued ⁠². If you are licensed in late 2026, your first license expires March 31, 2027. RIDOH says it sends renewal notices 60 days before expiration, and renewals are filed online through RIDOH’s licensing portal ⁠³.

Line up the building approvals first

The application asks for proof of three outside approvals, so you need them before you mail anything ⁠⁴:

1. Certificate of occupancy

   from your city or town.

2. A current State Fire Marshal inspection

   The form tells you to call the Fire Marshal’s office at 462-4215 to schedule a Life Safety Code / fire safety inspection.

3. A current food service license

   from the RIDOH Office of Food Protection (222-2750 for the application). You need it because the rule requires a noon meal prepared under the Rhode Island Food Code, 216-RICR-50-10-1 ⁠².

The rule adds a fourth item. You must get an annual certification from your local fire department approving the facility for program operation, and it must state your maximum daily occupancy. Copies go to RIDOH with the license application ⁠². The building must meet the Rhode Island Fire Safety Code (R.I. Gen. Laws ch. 23-28.1), the State Building Code (ch. 23-27.3), local zoning and the ADA ⁠². Before you build, alter or add to a facility, you must tell RIDOH, which may inspect the plans and comment ⁠².

Required spaces and equipment

Section 7.6 of the rule lists the rooms every program must have ⁠²:

• a dining area
• a food preparation area that meets the Food Code
• a project area with table and seating space (it can share the dining area)
• a group activity area
• a private, enclosed room for individual nursing services and counseling
• a properly equipped rest area
• handicapped-accessible bathrooms, placed as close to the activity area as possible, with doors that can be unlocked from outside
• at least one shower or other bathing accommodation

You also need:

• private workspace for staff
• a space where families can talk privately with staff
• storage
• a safe arrival and drop-off area
• at least two well-identified exits ⁠²

If you share a building with other services, the program must have “its own separate identifiable space” for activities during operating hours ⁠².

The rule also lists equipment you must keep on site: an emergency first aid kit, a scale for weighing participants, a blood pressure cuff and stethoscope, a thermometer, secure medication storage (refrigerated as needed), enough blankets, and a portable oxygen tank for emergencies ⁠². Smoking is banned in the facility. You must have fire extinguishers on each occupied level, an evacuation plan posted in each room, and evacuation drills run as the State Fire Marshal requires ⁠².

Staffing you must have on day one

Section 7.4.4(H) sets fixed minimums that do not change with program size, plus one threshold that does ⁠²:

Beyond those minimums, the program must have “an adequate number of qualified staff to meet the needs of its participants” ⁠². The rule sets no staff-to-participant ratio. Care plans are written by an interdisciplinary team of at least three professionals, one each in nursing, activities, and case management or social work ⁠². Plan your hiring so all three disciplines are covered. Licensed nurses and RIDOH-registered medication aides may give medications. Injectables, including insulin, must be given by a nurse ⁠².

Training

You need a written plan for at least 10 hours of staff training. It must cover 13 listed topics, including:

• orientation to your policies
• first aid and CPR for direct staff and drivers
• universal precautions and latex safety
• participant rights
• abuse reporting
• fire safety
• safe patient handling
• care planning
• medications
• confidentiality ⁠²

New staff must finish training within 30 days of hire and before working without direct supervision. All staff then need at least 10 hours of training every year ⁠². Every employee, consultant, intern, trainee and volunteer signs a confidentiality statement that goes in their personnel record ⁠².

Background checks and health screening

Anyone you hire who will have routine contact with participants, or access to their belongings or funds, needs a national, fingerprint-based criminal records check. It goes through the Attorney General’s Bureau of Criminal Identification (BCI) to the FBI, and it must be processed before employment or within one week of it. The employee pays for it ⁠¹.

BCI tells you only whether disqualifying information was found, not what it was. The disqualifying list includes murder, sexual assault, assault on a person 60 or older, patient abuse or neglect, felony drug offenses, exploitation of elders and felony larceny ⁠¹. If a new hire had a check within the past 18 months, you may ask BCI for a letter instead ⁠². You must keep evidence of every check on file, and failing to do so “may be grounds to revoke the license” ⁠¹.

Health screening on hire follows RIDOH’s health care worker rule, 216-RICR-20-15-7 ⁠².

Governance and paperwork RIDOH expects

This rule asks for more corporate structure than most states’ adult day rules. Your governing body must ⁠²:

• meet at least quarterly and keep minutes
• adopt an annual budget and get an annual audit by an independent certified public accountant
• hire a director and give that person authority over daily affairs
• adopt a charter or bylaws that state goals, civil rights compliance, standing committees, how assets are disbursed if the corporation is liquidated, and evidence of consumer input into policies
• approve a written plan of operation and review it at least once a year

Under § 7.4.2(N) ⁠², the program also needs a policy and procedure manual, with each policy signed by the executive director. It must cover:

• mission and philosophy
• organization structure
• personnel
• program description and evaluation
• admission and discharge
• environmental issues

You also need:

• written weather-cancellation and emergency-evacuation protocols, kept in the building and in every program vehicle, with a letter of agreement if your evacuation site is not affiliated with you
• a community education plan
• written agreements with occupational, physical and speech therapists
• an annual self-evaluation ⁠²

Program services

You must provide or arrange ⁠²:

• nursing services
• occupational, physical and speech therapy as prescribed
• personal care by aides under nurse supervision
• social, recreational and educational activities whenever the program is open
• mental health and substance use services when a physician indicates them
• transportation, or help arranging it

Each full day, a participant gets a noon meal equal to at least one-third of the USDA recommended daily allowance, plus two snacks. A RIDOH-licensed nutritionist or registered dietitian directs the menus ⁠².

Before admission, you need a physician’s notice with the person’s medical history and a physical exam from within the past year. In a documented crisis you may allow 30 days for it ⁠². A licensed staff member does the intake assessment and an RN reviews it. The interdisciplinary team writes a care plan within 30 days of enrollment and reviews it quarterly. A licensed team member writes progress notes at least monthly ⁠². Participant and medication records are kept five years from discharge ⁠². Staff must report suspected abuse, neglect or exploitation to the Director of Health within 24 hours ⁠².

Serving people with dementia

Serving even one participant with Alzheimer’s or another dementia counts as “Alzheimer dementia or other dementia special care services” ⁠². If you do, the rule requires the following ⁠²:

• Disclosure form. File RIDOH’s standard disclosure form with RIDOH and give it to every family considering placement. It covers eight areas: philosophy, termination criteria, assessment and service planning, staffing and training, physical environment, activities, family role, and program costs. Report significant changes to RIDOH when they happen.
• A registered nurse with dementia training or experience must be on staff and available for consultation at all times.
• A secure environment, such as a locked unit or secured perimeter, plus elopement procedures.
• 12 hours of dementia training within 30 days of hire, before working alone, for every new employee who helps these participants with personal care. It covers understanding dementias, communicating with people who have dementia, and managing behaviors.
• Written admission and discharge criteria specific to dementia care.

The application, in order

RIDOH’s adult day page links a single paper form, “Licensing Application and Instructions for Adult Day Care Programs.” The same form covers initial licensure, change of ownership, change of address and name changes ⁠³⁠⁴.

1. Get the building approved. Secure the certificate of occupancy, the State Fire Marshal inspection, the local fire department occupancy certification and the RIDOH food service license (see above) ⁠²⁠⁴.
2. Write the required documents. Section 7.4.2 of the rule describes the governance documents, policy manual, plan of operation and therapist agreements ⁠². The application asks you to attach 13 of them, including:
   • mission and philosophy
   • target population
   • anticipated number of participants
   • admission and discharge criteria
   • basic services
   • acknowledgement of participant rights
   • plan of operation
   • contracts and agreements
   • staffing pattern and staff profiles
   • days and hours of operation
   • participants’ non-financial obligations
   • closure schedule
   • procedure for unexpected closures ⁠⁴
3. Complete the form. It asks for:
   • your maximum daily enrollment capacity
   • whether you are for-profit or non-profit
   • the program director of record
   • mailing and location addresses (the location address is published on RIDOH’s website)
   • the owner, any parent organization, and the landowner if different
   • a printed list of every direct and indirect owner with percentages (for corporations, officers, directors and stockholding subsidiaries too) ⁠⁴
4. Clear your state taxes. Under R.I. Gen. Laws ch. 5-75, you must have filed all state tax returns and paid what you owe, or be on an installment agreement. Giving your SSN or FEIN is mandatory, and RIDOH sends it to the Division of Taxation ⁠⁴.
5. Sign the affidavit and mail it. Leave no blanks, because incomplete forms are returned. Mail the signed form and labeled attachments to Rhode Island Department of Health, 3 Capitol Hill, Room 306, Providence, RI 02908-5097 ⁠⁴.
6. Expect an inspection. By signing, you acknowledge that RIDOH may “enter without prior notice to inspect the entire premises and services, including all records” ⁠⁴. The rule gives RIDOH that right for any premises “for which an application has been received” ⁠². Once RIDOH has a complete application and you meet the statute and rule, it “may issue a license” ⁠².

RIDOH does not publish a processing time for adult day applications.

For questions, the application lists the Office of Facilities Regulation at (401) 222-2566 ⁠⁴. RIDOH’s adult day page lists the Licensing Unit at 401-222-5960, Room 105A, weekdays 8:30 a.m. to 3:30 p.m. ⁠³. The form and the rule give different room numbers (306 and 305), so confirm the mailing room by phone before you send ⁠²⁠⁴.

Inspections, deficiencies and ownership changes

RIDOH inspects as often as it decides, and its agents may enter “at any time without prior notice.” Refusing an inspection is grounds for suspension or revocation ⁠². After an inspection, RIDOH sends a notice of deficiencies within 15 days. You then have 15 days to submit a plan of correction, and RIDOH approves or rejects it within 15 days of receiving it ⁠². If you miss the deadline, your plan is rejected, or you do not carry it out, RIDOH may deny, suspend or revoke the license or curtail your activities ⁠².

If you plan a change of ownership, operator or location, or plan to close, give RIDOH written notice within 45 days of the pending change ⁠². A change of ownership voids the license immediately. The new owner must apply for a new license, and RIDOH may let the old license run up to six weeks while it processes the application ⁠². If a rule would cause you unnecessary hardship, you can request a variance in writing ⁠².

How Rhode Island adult day programs get paid

The Executive Office of Health and Human Services (EOHHS) publishes provider certification standards for adult day care, dated December 2015 ⁠⁶. To bill Medicaid, a program must ⁠⁶:

• be licensed by RIDOH as an adult day care program
• be enrolled as a Rhode Island Medicaid provider
• agree to follow the federal HCBS settings rule (CMS 2249-F/2296-F)

The standards add an operating requirement the license rule does not have: you must be open at least Monday through Friday, 8 hours a day ⁠⁶.

Before services start, you must get clinical authorization from the Medicaid agency for each Medicaid participant, and again after any six-month gap in services. The participant must meet the “Preventive Level of Care” under Rhode Island’s 1115 waiver ⁠⁶. Medicaid pays a Basic or an Enhanced rate, depending on the services you provide and the participant’s needs. It pays only for days attended and for no more than 6 days a week. Days under 5 hours, including transportation, are billed as partial-day units ⁠⁶. This guide does not quote rate amounts because the certification standards do not publish them.

If you plan to serve Medicaid members, design your hours, assessments and records around both documents from the start. The license rule sets the floor, and the EOHHS standards add the payment conditions.

Recent changes and rule status

The January 4, 2022 filing of the adult day rule was a periodic refile under R.I. Gen. Laws § 42-35-4.1, and the filing states that “no changes were made to the text” ⁠². The rule’s history lists an amendment effective April 30, 2018 and an emergency amendment that ran June 9 to October 7, 2020 ⁠². RIDOH’s fee rule has been amended several times since, most recently effective March 25, 2026, and the adult day license still carries no fee ⁠⁵. The fingerprint-check law has applied to anyone hired on or after October 1, 2014. Staff employed before that date are exempt for their current job only ⁠¹.

Sources

1. 1
   State of Rhode Island General Assembly, R.I. Gen. Laws § 23-1-52: Adult daycare program licensure Checked 12 Oct 2026 · Back to text ↑
2. 2
   Rhode Island Department of State, Licensing Adult Day Care Programs (216-RICR-40-10-7) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Rhode Island Department of Health, Adult Day Care Checked 12 Oct 2026 · Back to text ↑
4. 4
   Rhode Island Department of Health, Licensing Application and Instructions for Adult Day Care Programs Checked 12 Oct 2026 · Back to text ↑
5. 5
   Rhode Island Department of State, Fees for Public Health Services (216-RICR-10-05-2) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Rhode Island Executive Office of Health and Human Services, Provider Certification Standards: Adult Day Care (December 2015) Checked 12 Oct 2026 · Back to text ↑
7. 7
   State of Rhode Island General Assembly, R.I. Gen. Laws § 23-17.24-1: Adult supportive care homes, definitions Checked 12 Oct 2026 · Back to text ↑
8. 8
   Rhode Island Department of State, Licensing Home Nursing Care Providers and Home Care Providers (216-RICR-40-10-17) Checked 12 Oct 2026 · Back to text ↑
9. 9
   State of Rhode Island General Assembly, P.L. 2026, ch. 84, Article 12 (Relating to Health Care), Sections 10 and 20 Checked 11 Nov 2026 · Back to text ↑

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