CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Adult Day Health 10.27.25

Defines coverage, levels of care, clinical prerequisites, exclusions, billing modifiers, and coding for Adult Day Health programs for Medicaid members in Rhode Island (excluding certain subpopulations). Applies to Medicaid products only.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyAdult Day Health 10.27.25

Policy CodePolicy N/A

Change TypeAnnual review; content updates (historical)

Effective DateSep 1, 2013

Next Review DateN/A

Key ActionVerify member eligibility, obtain required authorizations prior to services, and document annual PCP face-to-face assessments and care plans with progress notes for Enhanced Levels.

SourceLink

POLICY UPDATE CHANGES

10/27/2025 Annual Policy Review. No content changes.

12/11/2024 Added language to disclaimer. Removed personal choice exclusion.

07/01/2024 Added preventative level of care language, and more detail to basic level and advanced level non skilled.

11/28/2023 Added language that all other modifiers outside of U1/U3 will not process correctly.

10/01/2022 Removed additional criteria from policy for Enhanced Level Skilled.

09/29/2021 Annual Policy Review Date. No Content Changes.

09/14/2020 Policy Review Date. Format Change.

09/01/2013 Policy Effective Date.

3Defined Levels of Care

2HCPCS Billable Codes

3Modifiers Defined