West Virginia medical adult day care center license: OHFLAC rules, space, nursing and Medicaid

West Virginia licenses only the medical model

Many states license every adult day program. West Virginia does not. The only adult day license OHFLAC issues is the Medical Adult Day Care Center license, and the rule treats the center as “a special type of ambulatory health care center” ⁠¹. The license sits in OHFLAC’s Assisted Living program and is a state license, not a federal certification ⁠²⁠³.

The rule defines a medical adult day care center as an ambulatory health care facility running “an organized day program of therapeutic, social, and health maintenance and restorative services” whose goal is to be an alternative to 24-hour institutional care for elderly or disabled adults who need those services because of physical and mental impairment ⁠¹. An adult means anyone 18 or older ⁠¹.

Two kinds of program are outside the rule ⁠¹:

• Social and recreational programs. The rule “shall not apply to day care programs for adults which are primarily social and recreational in nature, but which may occasionally offer medical screening clinics.” A senior center with an occasional blood-pressure clinic is the kind of program this describes.
• Behavioral health day programs. Three-to-eight-hour programs of a behavioral health center licensed under 71CSR25 are excluded, unless the program routinely offers medical treatment on top of behavioral health services.

No minimum number of participants appears in the rule. The trigger is the type of service, not the headcount. OHFLAC sets each center’s licensed capacity, which means the number it may serve at one time ⁠¹.

Being part of a licensed facility does not get you out of the rule. A day program run by a nursing home, hospital or other licensed health care facility must meet 71CSR20, and OHFLAC checks it separately from the host facility’s own license, even where staff, space and equipment are shared ⁠¹. Under the statute, ambulatory health care facilities run by the federal government are exempt from licensing, and the licensing article does not reach private offices of physicians, dentists and other practitioners ⁠⁷.

Do not confuse this license with West Virginia’s residential options. An assisted living residence houses four or more people overnight. A legally unlicensed health care home is a free registration for one to three residents. Both are 24-hour settings handled by the same OHFLAC program.

Rules on names, locations and advertising

You need the license before you establish, operate or advertise the center ⁠¹. The name and advertising may not use “clinic”, “hospital”, “residence” or any other word that suggests a different type of facility ⁠¹. A license covers one licensee at one center and cannot be transferred. If the licensee or center changes its name, tell OHFLAC within 15 days. Each center you own needs its own license ⁠¹. The statute also issues licenses “by type of services”, and a change in the type of services requires a new license ⁠⁸.

Operating without a license is a misdemeanor under W. Va. Code 16B-3-11. A first offense carries a fine of up to $100, up to 90 days in county jail, or both. A later offense carries a fine of up to $500. Each day a violation continues after conviction counts as a separate offense ⁠¹⁰. OHFLAC may also enter a building it believes is operating unlicensed. If entry is refused, it may ask the circuit court for a warrant ⁠¹.

Two questions to settle before you sign a lease: certificate of need and the building

Certificate of need

71CSR20 will not let OHFLAC issue an initial license for a project that is reviewable under the certificate of need law (W. Va. Code 16-2D) until the Health Care Authority has found, after a final conformance review, that the project matches its certificate of need. Evidence of compliance goes in with your license application ⁠¹. The application checklist includes a line for “Verification of compliance with CON Review” ⁠².

The statute does not answer clearly whether a medical adult day center is reviewable. Section 16-2D-8(a)(1) requires a certificate of need for “the construction, development, acquisition, or other establishment of a health care facility” ⁠¹¹. “Health care facility” covers any entity offering health services, licensed or not ⁠¹². The exemption list in 16-2D-11 names assisted living facilities but not adult day care ⁠¹³. Section 16-2D-8(b)(7) separately lists “establishing an ambulatory care center” among services that need a certificate of need regardless of cost, but the definitions section does not define that term ⁠¹¹⁠¹². A written request for a determination of reviewability costs $100 ⁠¹⁴. Neither the statute nor 71CSR20 says whether a new medical adult day care center is reviewable, and no Health Care Authority standard for adult day care turned up in the sources checked on October 12, 2026. Ask the Health Care Authority for a written determination of reviewability before you commit to a site, and ask OHFLAC to confirm in writing what it will accept as the “verification of compliance with CON Review” on the application.

The site and the building

Section 5 of the rule applies “in total to all proposed medical adult day care facilities” ⁠¹. Here is what it requires:

1. Site inspection before site work

   OHFLAC inspects the site of every proposed center, addition or renovation before you start site development or construction. The site must drain properly, sit above the 100-year flood plain, have a safe water supply, and have safety precautions if it is near railroads, freight yards, major roads or airports ⁠¹. OHFLAC posts a Site Inspection Request form for this facility type ⁠⁴.

2. Sealed drawings

   For new construction, additions, renovations or alterations, an architect or engineer registered in West Virginia signs and seals the drawings and specifications. One set goes to OHFLAC and one to the State Fire Marshal for approval. The same professional must inspect the work during construction ⁠¹. If substantial construction has not started within one year of plan approval, you need a written statement from OHFLAC that the approval is still valid ⁠¹.

3. Completion and pre-opening inspection

   When construction is substantially complete, you submit a substantial completion form signed by all parties and an inspection request. OHFLAC must approve the work before any new participants are admitted ⁠¹. A Pre-Opening Inspection Request form is posted for this facility type ⁠⁴.

4. You pay

   The applicant pays all fees for site inspections, drawing reviews and pre-construction inspections ⁠¹.

The building must meet the State Building Code, the State Fire Code (87CSR1), the ADA and any stricter local building or zoning codes ⁠¹. It must be a single-story structure or have all access and services on the ground floor ⁠¹. OHFLAC can refuse a license if the State Fire Marshal has not recommended the center for licensure ⁠¹.

Other rules shape the layout. Grab bars must be backed to carry a 250-pound concentrated load. Toilet and bath doors must swing outward and open from outside. You need a housekeeping closet with a service sink that participants cannot reach. Any hot water tank over 80 gallons needs a thermostatic mixing valve ⁠¹. The site needs an all-weather hard-surface road connecting directly to a highway ⁠¹. Unless OHFLAC approves in writing, you may not rent, lease or use any part of the center for anything else ⁠¹.

Who can hold the license and who must run it

The applicant must be at least 21 and must supply at least two letters of reference from reputable people who know them personally. For a corporation, association or government unit, the same evidence covers its members and the people in charge ⁠¹. The statute sets a lower floor of 18 ⁠⁸, but the rule’s 21 is what OHFLAC applies to this license. If the applicant is a corporation, partnership or trust, Attachment B of the application must list the governing body, the officers, and everyone with a proprietary interest of 10 percent or more, along with the same details for the owner of the premises ⁠².

OHFLAC may refuse or revoke a license for any of these reasons, among others ⁠¹:

• Financial instability, such as insufficient capital, delinquent accounts, bounced checks, or unpaid taxes or utilities.
• A history of abuse, fraud, or repeated violations in running any health care facility or caring for dependent people.
• A conviction for crimes related to caring for dependent people, found through a West Virginia State Police background check, or a listing on a state abuse registry.
• A license denied or revoked in any jurisdiction in the previous five years.
• False information given during licensing or a survey.
• Moving the program, or building or renovating, without OHFLAC approval.

Facility director. The center must employ a facility director who is at least 21. The director needs either two years of post-secondary education, or a high school diploma (or equivalent) plus five years of experience and training in social services or health care with elderly or disabled people, two of those years in a supervisory and administrative role. The director needs eight hours of training a year related to running a center ⁠¹. The director, or a staff member designated in writing, must be present and in charge at all times ⁠¹. If the director or supervising RN leaves for good, notify OHFLAC within 10 days. The center may not run more than 30 days without a qualified director or supervising RN ⁠¹.

Staffing, nursing and training

Source: 71CSR20 section 6.4 ⁠¹.

The RN oversees nursing and the care plans. A nursing note goes into each participant’s record at least monthly. When an LPN writes the note, the RN reviews and co-signs it ⁠¹. Volunteers count toward the 1:6 ratio only if they are professionally trained or certified in a health occupation and are oriented and trained like staff. If a participant has a poor outcome linked to too little supervision, OHFLAC may order you to add staff ⁠¹.

Screening before hire. Before hiring, you must check every employee against the West Virginia State Police central abuse registry, the state nurse aide abuse registry, the relevant licensing board for licensed staff, and the Bureau for Children and Families’ records of substantiated abuse or neglect. You may not hire or keep anyone listed. Repeat the checks after a break in employment of a year or more ⁠¹. Each employee needs a TB skin test or chest X-ray before working with participants and a TB screening every year after that ⁠¹.

Training. New employees must be trained before they work unsupervised, and no later than their first 14 days, then every year. The training covers emergency and disaster plans, policies, participant rights, confidentiality, abuse prevention and reporting, complaints, infection control and the needs of elderly and disabled people. It also includes at least two hours on Alzheimer’s disease and related dementias. New hires also get at least five days of supervised on-the-job training ⁠¹. Every employee must hold current first aid and CPR training ⁠¹.

The program you must run once open

Many of the requirements below go into the policies, forms and contracts OHFLAC expects to see. Draft them before the inspection.

• Hours. Open regularly for 4 to 14 hours a day, at least five days a week, during hours that cover a normal caregiver work week ⁠¹.
• Admission limits. Do not admit anyone who needs ongoing or extensive nursing care, or a level of service the center is not licensed for or does not provide ⁠¹.
• Assessment clock. The director or RN holds a pre-admission interview. A health assessment, signed by a physician or other authorized licensed professional, must be dated no more than 60 days before admission or done within five working days after it, and must include TB screening. A licensed professional completes a functional needs assessment within seven attendance days. The RN writes an initial service plan on the first day. The multidisciplinary team writes the full service plan within 14 attendance days and reviews it every quarter ⁠¹.
• Activities. At least 20 hours a week and four hours a day of scheduled activities, alternatives for people who will not join a group, and a large-print weekly calendar posted at least a week ahead ⁠¹.
• Meals. Participants attending four hours or less get one meal. Those attending five to eight hours get one hot meal and two snacks. Those attending more than eight hours get two hot meals and two snacks. A registered dietitian prepares or approves the menus at least two weeks ahead, and food service must meet the Food Establishments rule (64CSR17) ⁠¹.
• Medications. Medications are given only on a prescriber’s order. A licensed professional must document whether a participant can self-administer. Medications are kept locked in their original pharmacy containers, and Schedule II drugs go behind two locks with a separate key ⁠¹.
• Restraints. Physical restraints are allowed only in an emergency, on a physician’s order, for no more than two hours, and only cloth vests or soft belts applied by trained staff ⁠¹.
• Contracts and notices. Each participant receives an admission packet and a written contract that lists services, the price and what changes it, and the refund policy. Give 30 days’ written notice before a rate change or a discharge ⁠¹. Staff and volunteers may not manage participants’ personal funds ⁠¹.
• Incident and abuse reporting. Report major incidents to OHFLAC no later than the next business day. Report suspected abuse or neglect to Adult Protective Services immediately, send the APS form within 48 hours, and notify OHFLAC within 72 hours ⁠¹.
• Emergency plan. You need a written emergency operations plan that includes an alternate shelter agreement and an emergency transportation policy. Review it every year and rehearse it with all staff every year. Show each new participant how to evacuate on their first day ⁠¹.
• Records. Keep participant records for five years after discharge and personnel records for three years after an employee leaves ⁠¹.

Advertising dementia care needs a second license

West Virginia’s Alzheimer’s Special Care Standards Act counts adult day care centers as covered facilities ⁠¹⁶. Under 71CSR19, a facility that advertises, markets or promotes a special Alzheimer’s or dementia program must first get an additional license from OHFLAC. It applies before opening and again with each annual renewal, and it gives families a written disclosure statement before admission ⁠¹⁵. The dementia program needs an average of at least 2.25 hours of direct-care staff time per participant per day, or more if the facility’s own licensing rule requires it, and at least two direct-care staff whenever more than five people with dementia are present ⁠¹⁵. 71CSR20 separately requires 40 square feet per participant for dementia programming ⁠¹. You can serve people with dementia without this designation. You cannot promote a dementia program without it.

Applying, step by step

The application and renewal forms posted by OHFLAC still carry the former Department of Health and Human Resources letterhead and a 1 Davis Square mailing address ⁠²⁠³. The Office of Inspector General page lists OHFLAC at the State Capitol Complex, Building 6, Suite 825, Charleston, WV 25305, phone 304-558-0050 ⁠⁵. The sources do not say which address OHFLAC wants medical adult day care applications sent to or whether a reissued form exists, so call 304-558-0050 and confirm the mailing address and current form before you mail the packet.

1. Settle certificate of need and the site

   Get the Health Care Authority’s reviewability answer. Then request OHFLAC’s site inspection before any site work, and submit sealed drawings to OHFLAC and the Fire Marshal if you are building or renovating ⁠¹⁠⁴.

2. Register the business

   The application asks for a West Virginia business license number and the center’s FEIN. OHFLAC checks that the center has no account in default with the state’s workers’ compensation or unemployment programs before it issues the annual license ⁠².

3. Assemble the packet

   The checklist on the initial application lists the completed and notarized application, the $100 fee payable to OHFLAC, a preliminary statement of operations or balance sheet (Attachment A), the director’s proof of education, a criminal background (CIB) card with its fee payable to the West Virginia State Police by business check or money order, photographs of the center, a copy of the lease if the space is leased or rented, and verification of certificate of need compliance ⁠². The form also asks for an organizational chart with staffing by position, the supervising RN’s name and license number, the services you will offer and any extra charges, and your primary hours ⁠². The rule requires the budget to show projected monthly income, owner reimbursement, lease payments and the fees you will charge ⁠¹.

4. File at least 90 days before opening

   Send the packet and the $100 fee at least 90 days before the date you plan to start operating. OHFLAC recommends certified mail ⁠².

5. Pass the licensure inspection

   OHFLAC will not inspect until it has judged the application complete and your documents show the center is ready. The initial license is issued only after a satisfactory inspection ⁠¹. If deficiencies are cited, OHFLAC sends the report within 15 days and you return a signed plan of correction within 15 working days ⁠¹.

6. Post the license

   Post the license, participant rights and responsibilities, and the abuse hotline and OHFLAC phone numbers in a conspicuous place ⁠¹⁠⁹.

Fees

As published on October 12, 2026, 71CSR20 sets a $100 non-refundable initial application fee and a $100 non-refundable renewal fee ⁠¹. The statute says an ambulatory health care facility pays “a reasonable fee to be determined by the director, based on the number of patients served” ⁠⁹. The initial application form also says a separate initial or change-of-ownership licensure fee, based on the number of patients, must be paid before the license is issued ⁠². OHFLAC’s facility fee schedule effective June 1, 2026 lists no line for medical adult day care ⁠⁶. The sources do not say whether, or how much, OHFLAC charges under that statute for a medical adult day care center beyond the $100 application fee, so ask OHFLAC for the total initial fee before you file. You also pay the State Police background check fee, and any site inspection and plan review fees for construction ⁠¹⁠².

Renewal, inspections and changes

Every license expires on June 30 after it is issued, for a term of no more than one year ⁠¹⁠⁹. Postmark or hand-deliver the renewal application and $100 at least 90 days before expiry, which for a June 30 expiration means by about April 1 ⁠¹. The renewal form asks for your current approved capacity and census, your rates, an organizational plan, and a balance sheet or statement of operations ⁠³. If you file a timely renewal with the fee before the license expires, the license stays in effect until the next June 30, a suspension or revocation, or the issuance of a new license, whichever comes first ⁠⁹. Renewal requires substantial compliance with the rule and all requested financial information ⁠¹.

To raise licensed capacity, you need OHFLAC’s prior written approval and a plan of operation submitted with the renewal ⁠¹. Moving, rebuilding or adding permanently fixed equipment also needs approval in advance ⁠¹.

OHFLAC makes at least one unannounced inspection every 12 months and also investigates complaints ⁠¹. Deficiencies that pose an immediate and serious threat must be fixed at once. Others must be corrected within 60 days of the inspection unless OHFLAC allows more time ⁠¹. If OHFLAC rejects your plan of correction, you have 15 working days to send a revised one ⁠¹. Participants are entitled to see the latest survey deficiencies, any complaint investigation from the previous 12 months, and your plan of correction ⁠¹. Requests to waive a requirement go to OHFLAC on its waiver form. A waiver is granted only if it will not harm participants’ health, safety, welfare or rights ⁠¹.

Getting paid: the Aged and Disabled Waiver

West Virginia’s Aged and Disabled Waiver (ADW) Medicaid program added medical adult day care as a service; the manual’s revision history says it “will be available June 2023” ⁠¹⁷. The Bureau for Medical Services’ Chapter 501 manual, effective July 1, 2025, bills it under procedure code T2021. A full day (U4 modifier) requires at least 7 hours and a half day (U8 modifier) at least 4 hours, and both need prior authorization ⁠¹⁷.

To bill the waiver, a center must ⁠¹⁷:

• Hold an OHFLAC medical adult day care license and follow the licensure rule. The manual still cites the rule by its former number, 64CSR2.
• Enroll as a West Virginia ADW Medicaid provider and sign a provider agreement. Like all ADW agencies, it must be certified by the waiver’s operating agency and meet Chapter 300 provider participation requirements.
• Screen staff through WV CARES (West Virginia Clearance for Access: Registry and Employment Screening) and check them against the federal Office of Inspector General Medicaid exclusion list. OHFLAC verifies licensure and staff training every year. Fingerprint checks are repeated every five years, and WV CARES runs the exclusion check monthly.
• Pass the operating agency’s review under the federal home and community-based settings rule.

Approved providers may also bill non-emergency transportation between the member’s home and the center. Meals served under the waiver may not amount to a full nutritional regimen of three meals a day ⁠¹⁷. The manual text does not state reimbursement rates, so get them from the Bureau for Medical Services before you build a budget around waiver days.

Recent changes

• Rule renumbered under the Office of Inspector General. The former 64CSR2 was reassigned as 71CSR20, filed and effective May 28, 2025, under authority of W. Va. Code 16B-3-8. The accompanying memo describes the changes as technical: the new title number, references to the Department of Health and Human Resources replaced, Inspector General and OHFLAC definitions added, and citations updated ⁠¹. The rule now sunsets on August 1, 2030 ⁠¹. The dementia program rule, 71CSR19, was renumbered on the same date with the same sunset ⁠¹⁵.
• Medicaid coverage added. The BMS manual’s revision history lists medical adult day care as an Aged and Disabled Waiver service that “will be available June 2023” ⁠¹⁷.
• Older forms in circulation. The posted application still cites the old Chapter 16-5B statute and the former department ⁠². The licensing statute now sits in Chapter 16B, Article 3 ⁠⁷.

Sources

1. 1
   West Virginia Secretary of State, Code of State Rules, 71CSR20, Licensure of Medical Adult Day Care Centers (effective May 28, 2025) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Office of Health Facility Licensure and Certification, Initial or Change of Ownership License Application for Medical Adult Day Care Checked 12 Oct 2026 · Back to text ↑
3. 3
   Office of Health Facility Licensure and Certification, Renewal License Application for Medical Adult Day Care Checked 12 Oct 2026 · Back to text ↑
4. 4
   Office of Health Facility Licensure and Certification, Facility type: Medical Adult Day Care Center (forms, rules and laws) Checked 12 Oct 2026 · Back to text ↑
5. 5
   West Virginia Office of Inspector General, Office of Health Facility Licensure and Certification Checked 12 Oct 2026 · Back to text ↑
6. 6
   West Virginia Office of Inspector General, 2026-2027 Facility Fee Schedule, Effective June 1, 2026 Checked 12 Oct 2026 · Back to text ↑
7. 7
   West Virginia Legislature, W. Va. Code §16B-3-1: Health facilities to obtain license; exemptions Checked 12 Oct 2026 · Back to text ↑
8. 8
   West Virginia Legislature, W. Va. Code §16B-3-2: Hospitals and institutions to obtain license; qualifications of applicant Checked 12 Oct 2026 · Back to text ↑
9. 9
   West Virginia Legislature, W. Va. Code §16B-3-4: License fees; expiration and renewal Checked 12 Oct 2026 · Back to text ↑
10. 10
    West Virginia Legislature, W. Va. Code §16B-3-11: Penalties Checked 12 Oct 2026 · Back to text ↑
11. 11
    West Virginia Legislature, W. Va. Code §16-2D-8: Proposed health services that require a certificate of need Checked 12 Oct 2026 · Back to text ↑
12. 12
    West Virginia Legislature, W. Va. Code §16-2D-2: Definitions (certificate of need) Checked 12 Oct 2026 · Back to text ↑
13. 13
    West Virginia Legislature, W. Va. Code §16-2D-11: Exemptions from certificate of need Checked 12 Oct 2026 · Back to text ↑
14. 14
    West Virginia Legislature, W. Va. Code §16-2D-7: Determination of reviewability Checked 12 Oct 2026 · Back to text ↑
15. 15
    West Virginia Secretary of State, Code of State Rules, 71CSR19, Alzheimer's/Dementia Special Care Units and Programs (effective May 28, 2025) Checked 12 Oct 2026 · Back to text ↑
16. 16
    West Virginia Legislature, W. Va. Code §16B-11-3: Definitions (Alzheimer's Special Care Standards Act) Checked 12 Oct 2026 · Back to text ↑
17. 17
    West Virginia Bureau for Medical Services, BMS Provider Manual, Chapter 501: Aged and Disabled Waiver (effective July 1, 2025) Checked 12 Oct 2026 · Back to text ↑

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