4500, Day Activity and Health Services

Revision 17-1; Effective June 1, 2017

Day Activity and Health Services (DAHS), also called adult day care, is a Medicaid state plan service available to STAR Kids members ages 18 and older who require the service because of a chronic medical condition and are able to benefit therapeutically from the service. DAHS provides attendant care in a facility setting under the supervision of a nurse. Services include nursing, physical rehabilitation, nutrition, social activities and transportation when another means of transportation is unavailable. STAR Kids managed care organizations may not require DAHS providers to obtain a denial or explanation of benefits from a member's primary insurance before seeking reimbursement for DAHS.

4510 Assessment for Day Activity and Health Services

Revision 22-2; Effective September 1, 2022

The potential for therapeutic benefit must be established by a physician's assessment and requires a physician's order.

A Day Activity and Health Services (DAHS) facility nurse must complete a health assessment for each STAR Kids member at the facility. The assessment may be conducted by a registered nurse (RN) or licensed vocational nurse (LVN), based upon the member's condition at the time of initial assessment. The DAHS facility nurse completes a health assessment at either the facility or the member's home. Health assessments must be conducted, at minimum, when:

  • members need initial assessment for prior authorization by a STAR Kids managed care organization;
  • members transfer to a new facility (conducted by the new facility);
  • at reauthorization; and
  • the DAHS nurse determines a member needs to be reassessed.

The member or their legally authorized representative must sign the health assessment each time the nurse completes or revises the form. The health assessment must identify specific conditions that may affect a member's functioning.

4511 Reassessment for Day Activity and Health Services

Revision 22-2; Effective September 1, 2022

Reassessment by a physician is required at least every 12 months for continued authorization. For this service, a physician assessment must be no older than 90 days from the date at which an authorization is requested.

A member is reassessed at regular intervals by the facility nurse. In addition, the facility nurse assesses the member for nursing, physical rehabilitation, and nutritional services when:

  • a member first enters the facility;
  • transferring from another Day Activity and Health Services facility; and
  • a member's condition changes. If the change in condition necessitates, the facility nurse coordinates with the member's service coordinator or physician for a physician assessment.

4520 Day Activity and Health Services Providers

Revision 22-3; Effective Dec. 1, 2022

To provide Day Activity and Health Services (DAHS), a facility must hold a current license from the Texas Health and Human Services Commission and comply with Texas Administrative Code, Title 40, Part 1, Chapter 98, Adult Day Activity and Health Services Requirements.

DAHS facilities are responsible for:

  • Nursing services, which include a member’s nursing assessment, assistance with prescribed medications, counseling concerning health needs, and supervision of personal care services (PCS).
  • Physical rehabilitative services, which include restorative nursing and group and individual exercises with range of motion exercises.
  • Nutrition services, which include:
    • one hot noon meal a day;
    • a mid-morning and mid-afternoon snack;
    • preparation of foods required for special diets; and
    • dietary counseling and nutrition education for the individual and their family.
  • Transportation, including to and from the facility, on an activity outing, and to provide therapies if the member requires specialized services on days of attendance at the DAHS facility. The provider must:
    • coordinate the use of other transportation resources within the community;
    • make every effort to have families transport individuals;
    • manage upkeep and operation of facility vehicles, including liability insurance. Vehicles used by the facility must be maintained in a condition to meet the vehicle inspection requirements of the Texas Department of Public Safety; and
    • have sufficient staff to ensure the safety of members being transported to and from their homes.
  • Activities and other supportive services:
    • Activities offered at the facility must be meaningful, fun, therapeutic and educational.
    • A provider must offer at least three different scheduled activities in at least one or more of the following activities:
      • exercise;
      • games;
      • educational or reality orientation; and
      • crafts.
    • A provider must offer at least one of the following activities, at cost to the provider, monthly:
      • trips or special events; or
      • cultural enrichment.