Adult Day Care in Nevada

All states: adult day services map

Nevada adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Nevada?

Nevada has one license for every adult day center: a license as a facility for the care of adults during the day, which state law defines as a place that provides daytime care for aged or infirm people (NRS 449.004). The license does not separate social and health models. That split comes from Nevada Medicaid, which pays for Adult Day Health Care (ADHC) and for social Adult Day Care through two different programs.

Three layers of rules can apply to a Nevada center, and each comes from a different agency:

• Licensing (HCQC). NRS Chapter 449 and the adult day regulations at NAC 449.4061 to 449.4089. These cover the license, fees, staffing, space, services, admission and records for every center, whatever the payer. A licensed center may also offer medical or ancillary services if it meets the added rules on program evaluation, assessments, care plans and menus in NAC 449.4086 to 449.4089.
• Medicaid (Nevada Medicaid, the Division of Health Care Financing and Policy, now within the Nevada Health Authority). Adult Day Health Care is a 1915(i) state plan benefit described in Medicaid Services Manual (MSM) Chapter 1800. A 1915(i) benefit lets Medicaid pay for home and community services as part of the regular state plan. Social Adult Day Care is paid through the Home and Community-Based Services Waiver for the Frail Elderly, a 1915(c) waiver described in MSM Chapter 2200 and run day to day by the Aging and Disability Services Division (ADSD).
• Other funding. Clark County Social Services contracts with licensed adult day providers for county-funded care.

Adult day health care vs adult day care. Under Medicaid, ADHC adds nursing, medication administration, nutrition assessment and care coordination, and the center must employ a full-time registered nurse. Frail Elderly waiver Adult Day Care is a social service focused on social interaction in a safe setting. Both must hold the same state license.

Where the layers overlap, the licensing rules set the baseline for every center, and Medicaid ADHC is the strictest layer because it adds nursing staff and a full-time program director. We did not find a separate dementia license or dementia program model in state law, the regulations or the Medicaid manuals.

Do you need a license to open an adult day center in Nevada?

Yes. No person or government agency may operate a facility for the care of adults during the day without a state license (NRS 449.030), and we found no exemption for private-pay or social-only programs. The license lasts 1 year and is tied to one owner and one location.

What the application needs. Under NAC 449.011, an application includes:

• Proof of identity and the license fee.
• Personal and financial references for the past 3 years and full ownership information.
• Evidence that the building meets safety, health, building and fire codes, plus copies of the certificate of occupancy, business license, any special use permits and the lease.
• The maximum number of clients allowed in the center at one time. This capacity is shown on the license.

Before the license is issued.

• Building plans for new construction or remodeling must be reviewed and approved by the state, and a center is not approved until construction is finished and an on-site survey is done. The center must meet local zoning, fire, health and building codes, and the stricter of state or local rules applies (NAC 449.4063).
• You must give the state a certificate of liability insurance, and the policy must give the state 30 days notice before it is cancelled or not renewed (NAC 449.4069).
• The applicant must complete training on recognizing and preventing abuse of older people (NRS 449.093) and submit fingerprints for an FBI background report and a Statewide Central Registry check (NRS 449.122).

The state agency's adult day application checklist and plan review pages no longer load, so we could not confirm the step-by-step process from the agency itself. Ask HCQC for the current application packet.

Fees. License fees are nonrefundable and set in NAC 449.013:

• 50 or fewer clients: $1,164 initial, $814 renewal.
• More than 50 clients: $1,753 initial, $1,227 renewal.

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult day centers in NRS 449 or the adult day regulations. Confirm with HCQC before you sign a lease.

One license per site and per owner. A license applies only to the person it is issued to and only to the premises named on it, and it cannot be transferred (NRS 449.080). Each site needs its own license. An adult day center run alongside another medical facility or facility for the dependent must be licensed as a separate and distinct unit (NAC 449.4067).

Buying a center. Because licenses cannot be transferred, a new owner needs its own license. We did not find a set notice period for a change of ownership, so contact HCQC early in any purchase.

Renewal and inspections. The license expires 1 year after it is issued (NRS 449.089). Renewal applications are due by November 15 of the year the license expires. A late filing by December 31 adds a charge of half the renewal fee, and a license that is not renewed before it expires requires a new application. The state may inspect before renewing (NAC 449.0116). We did not find a fixed routine inspection schedule. The licensee must also repeat the elder abuse prevention training every year before renewal.

Medicaid enrollment. Centers that bill Medicaid also enroll as Medicaid providers, which adds its own rules (see the Medicaid section below).

What are the staffing rules for adult day centers in Nevada?

Nevada does not set a numeric staff-to-participant ratio in any layer. The licensing rules require enough staff for the building, the number of clients and the services offered, with an employee supervising clients at all times. Centers billing Medicaid for Adult Day Health Care must also employ a full-time registered nurse and have a nurse on site whenever a Medicaid participant attends.

• Licensing (HCQC): no ratio specified. Each center must have the number and kind of employees its layout, census and services require (NAC 449.4072), and a client must be supervised by an employee at all times during operating hours (NAC 449.40723).
• Medicaid ADHC (1915(i)): no ratio specified, but the center must employ a full-time RN with at least one year of experience with seniors, people with disabilities or people with aggressive behavior. An RN, or an LPN supervised by an RN, must be physically on site whenever a Medicaid recipient is there (MSM 1803.3B).
• Medicaid Frail Elderly waiver: no ratio specified, and the waiver adds no staffing standard beyond the license.
• Dementia or high-needs participants: no ratio specified in any layer.

Minimum staff on site. At least one employee trained in first aid and CPR must be on the premises at all times (NAC 449.4079).

Volunteers. Volunteers and outside consultants may be used to meet client needs. They must meet the same standards as paid staff doing similar work, except that a volunteer needs only a tuberculin test rather than a full physical.

Director. Under the license, the director must be at least 21, hold a high school diploma or equivalent, and be suited to working with aged and infirm adults, and must name a similarly qualified acting director for absences. Medicaid ADHC centers must employ a full-time program director with at least two years of education or experience with seniors, people with disabilities or people with aggressive behavior, plus qualified direct care staff and janitorial, housekeeping and activity staff.

Medications. If a client cannot take medication on their own, an employee licensed to give medications must give it. Trained unlicensed staff may help with a few listed tasks, such as blood glucose testing, auto-injected insulin and weighing (NAC 449.4081, 449.40815).

Training. All employees and volunteers complete a general orientation, receive the center's policies and procedures, and get at least 12 hours of training at the center each year (NAC 449.40725). The administrator and every employee who provides care must complete training on recognizing and preventing abuse of older people before giving care and every year after (NRS 449.093). Medicaid 1915(i) providers also give paid and unpaid staff one hour of HCBS Settings Rule training each year.

Background checks. Within 10 days after hiring, the center must collect fingerprints for a state and FBI criminal history check, check the Statewide Central Registry, and verify any required licenses. The check must be repeated at least every 5 years (NRS 449.123).

Health screening. Before starting work, direct service employees and contractors need a health certificate showing they are free of active tuberculosis and a TB screening test from the past 12 months, then annual TB screening unless a documented risk assessment allows less often (NAC 441A.375). We did not find other required vaccinations.

What does an adult day center in Nevada have to provide?

Every licensed Nevada center helps clients with daily activities as needed, offers activities suited to each client, watches for health changes, and serves a meal to anyone there 5 hours or more. Centers need at least 40 square feet of indoor space per client and one toilet for every 10 clients. Medicaid ADHC centers add nursing, nutrition assessment and care coordination.

Services every center provides. Under NAC 449.4079, each center must:

• Help clients with activities of daily living as needed and provide activities suited to each client.
• Observe each client's health and tell the family about significant changes.
• Set medication procedures, provide fluids, and keep a first aid and CPR trained employee on site.
• Give information about other community agencies.
• Publish a monthly activity calendar for clients and families.

Medicaid ADHC services. ADHC covers nursing (assessment, care planning, treatment, medication administration and supervision of direct care staff), nutrition assessment and planning, care coordination, help with daily activities in the plan of care, social activities and meals. Services are generally given four or more hours a day, one or more days a week, up to 6 hours a day (MSM 1803.3A and the 1915(i) state plan attachment).

Meals. A client present 5 hours or more must be served a meal, and a client present more than 6 hours gets added nourishment. Each meal must supply one third of the recommended daily allowances. If meals are prepared on site, a licensed dietitian must consult at least 4 hours a month. Menus are planned a week ahead, posted and kept for 6 months (NAC 449.4082, 449.4089). Under the Frail Elderly waiver, meals at the center must not make up a full daily regimen of three meals.

Transportation. The licensing rules do not address transportation. Under Medicaid, rides are not part of the adult day service. They are covered through the state plan non-emergency transportation program (MSM 1806 for ADHC, and the Frail Elderly waiver service definition). Frail Elderly waiver providers that transport must carry auto insurance.

Space and capacity. Under NAC 449.4074 and 449.4082:

• At least 40 square feet of indoor space per client, not counting maintenance areas, and enough room for a full range of activities and services.
• At least one toilet for every 10 clients.
• At least two well-identified exits, slip-resistant floors, locked medication storage, secure storage for client belongings, free local telephone service for clients, and adequate parking and pick-up areas.
• A dining area separate from food preparation, with sturdy tables and chairs for the licensed number of clients and tables that fit wheelchairs.

Hours. We did not find a minimum number of days or hours a center must be open. Medicaid limits how long a participant may attend (up to 6 hours a day), not how long a center is open.

Written policies. Each center needs written policies on admission, discharge and care of clients, on employees, and on fiscal and administrative procedures, reviewed at least once a year (NAC 449.4071). Other required documents include:

• An admissions policy with a nondiscrimination statement and eligibility requirements, signed by the director and the client (NAC 449.4077).
• Medication procedures.
• A fire and emergency plan, posted where people can see it, understood by all employees and reviewed every year.
• A records policy covering use, removal and release of client records.
• For centers offering medical or ancillary services, a written plan for an annual evaluation of the program (NAC 449.4086).

Safety. An evacuation drill must be held every month, with records kept for 12 months (NAC 449.4075).

Advertising. Ads and promotional materials must accurately describe the services the center actually offers (NAC 449.407). Medicaid 1915(i) providers also may not use unsolicited door-to-door, phone, mail or email marketing, or offer incentives to move recipients from one provider to another (MSM 1803.1B).

What rules protect participants in Nevada adult day centers?

Nevada requires a recent physical exam and a physician's statement before a client is admitted, and client files must be kept for 5 years after the person stops attending. Families must be told right away about any accident, injury or illness. Centers that bill Medicaid also report serious occurrences within 24 hours.

Before admission. Under NAC 449.4078, a client must provide:

• A physical exam by a physician, physician assistant or APRN within the past 6 months.
• A summary of medical history from the past 6 months.
• A physician's statement that the center is appropriate for the client.
• Any special diet needs, and the name of a physician to call in an emergency.

Enrollment agreement. The client and director sign the admissions policy. We did not find other required contents for an enrollment agreement.

Assessment and care plan. In centers that offer medical or ancillary services, staff make an initial written assessment at admission and a fuller assessment, including the plan of care, within 30 days. Needs are reassessed against the care plan at least every 3 months (NAC 449.4087, 449.4088). For Medicaid ADHC, a Medicaid Health Care Coordinator contacts the applicant within seven working days to assess them, the plan of care must be signed within 60 calendar days, and the authorization lasts 12 months (MSM 1803.6).

Rights and disclosures. Each client must be treated with dignity and kept free from abuse, and restraints, or sedatives used in place of restraints, require a physician's order (NAC 449.4081). At or before admission, the center must give each participant copies of its license and any complaint summaries, investigation reports and disciplinary actions, and must tell all participants' representatives about a disciplinary action within 3 working days (NRS 449.2486).

Discharge. When a client leaves for good, the center gives a written summary of care with recommendations and any referrals (NAC 449.40833). We did not find required discharge reasons or a notice period for adult day participants. For Medicaid ADHC, Medicaid itself can end services for reasons such as loss of eligibility, non-cooperation, moving out of state or needs higher than the program can meet, and it sends a Notice of Decision.

Attendance and records. Client files are kept in a locked, fire-resistant place for 5 years after the client permanently stops attending (NAC 449.40835). Medicaid ADHC centers keep a daily attendance log and a nursing log (see the Medicaid section). We did not confirm a separate Medicaid record retention period.

Incidents.

• The next of kin, guardian or responsible person must be told immediately about any accident, injury or illness (NAC 449.4081).
• A fire or disaster must be reported to the Bureau within 24 hours (NAC 449.4075).
• Medicaid 1915(i) providers report serious occurrences, such as abuse, unplanned hospital stays, injuries needing medical care, medication errors needing outside care, loss of contact for three scheduled days and death, within 24 hours on the web-based Serious Occurrence Report form, with updates within five business days (MSM 1803.1B).
• Suspected abuse or neglect must be reported as state law requires, no later than 24 hours, and ADSD accepts these reports.

How does Medicaid pay for adult day in Nevada?

Nevada Medicaid pays for adult day through two programs, both billed by the day for an authorized 6-hour day under code S5102. Adult Day Health Care under the 1915(i) benefit pays $57.20 a day, and social Adult Day Care under the Frail Elderly waiver pays $42.00 a day, according to the July 2026 fee schedules. Every day must be authorized in advance and backed by attendance records.

1915(i) Adult Day Health Care (Provider Type 39). Nevada Medicaid runs this benefit, and its Health Care Coordinators decide eligibility and authorize services. It serves Medicaid members 18 or older who live in the community, need hands-on help or prompting with at least two activities of daily living, and have one listed risk factor, such as social isolation, a chronic condition needing RN supervision, aggressive behavior needing RN supervision or medication administration, or a brain injury needing trained supervision (MSM 1803.1). People living in a group home, assisted living or another residential setting paid a 24-hour per diem are not eligible.

• Codes and units: S5102 per day for an authorized 6-hour day; S5100 per 15 minutes when fewer than 6 hours are authorized. The two codes cannot be billed for the same person on the same day.
• Rate: S5102 $57.20 per day, in effect since October 1, 2017, on the Provider Type 39 fee schedule. No S5100 rate appears on the current schedule, so ask Nevada Medicaid what it pays for shorter days.
• Limit: up to 6 hours a day.
• Claims: every service needs Medicaid authorization, the authorization number goes on the claim, claims are sent monthly, and days the person was in another medical facility cannot be billed (Provider Type 39 billing guide).
• Provider rules: the center must hold its state license and email 1915i@dhcfp.nv.gov within 24 hours of a closure, suspension or other action by HCQC. Medicaid rechecks a center's qualifications every five years, and the state plan says HCQC verifies them every six years.

Frail Elderly waiver Adult Day Care (Provider Type 48). Nevada Medicaid runs this 1915(c) waiver with ADSD as the operating agency. It serves people 65 and older who meet nursing facility level of care, and ADSD and the Division of Welfare and Supportive Services decide eligibility (MSM 2203). The waiver was renewed for July 1, 2025 through June 30, 2030.

• Codes and units: billed as Social Adult Day Care, S5102 per day and S5100 per 15 minutes (Provider Type 48 billing guide).
• Rate: S5102 $42.00 per day, in effect since July 1, 2021, on the Provider Type 48 fee schedule. No S5100 rate appears on the current schedule.
• Limit: the plan of care sets the days per week, and the case manager may authorize up to 6 hours a day. Therapies are paid separately under the state plan.
• Provider rules: a state adult day license, workers compensation, commercial general liability insurance of $2 million aggregate and $1 million per occurrence, and crime insurance naming the Division of Health Care Financing and Policy, plus auto insurance if the center transports. Qualifications are checked at enrollment and every five years (Frail Elderly waiver application).

Transportation. Rides are not part of either adult day service. They go through the state plan non-emergency transportation program instead.

Attendance documentation.

• ADHC centers keep a daily attendance log with time in and time out, signed or initialed by the participant or a designated representative, plus a nursing log of plan of care services signed by an appropriate staff member at least monthly (MSM 1803.3B). 1915(i) participants are expected to sign or initial service logs unless they cannot because of cognitive or physical limits.
• Frail Elderly waiver providers keep attendance records for each participant, claims must match the dates and times on those records, and days a participant does not attend cannot be billed (MSM 2203.10).

We did not find a requirement for a specific electronic attendance system for adult day. The manuals require logs. We also did not check whether adult day is paid through Nevada Medicaid managed care plans or directly by the state, so ask Nevada Medicaid how to bill.

Can a private-pay adult day center operate in Nevada without Medicaid?

Yes, a center can be fully private pay, but it still needs a state license. Nevada's license requirement applies to every facility for the care of adults during the day, and we found no exemption for private-pay or social-only programs. Because every center must be licensed, the rules do not describe what an unlicensed program may do.

Protections for private-pay participants. The same licensing rules apply whoever pays. That includes the signed admissions policy with a nondiscrimination statement, the dignity and restraint rules, and the right to see the center's license and any complaint, investigation and disciplinary reports at or before admission (NRS 449.2486). We did not find fee disclosure or contract rules specific to private-pay participants.

Checking a center. HCQC publishes a Find a Health Facility search and an Unlicensed Facility Listing. Families can use these to check whether a center is licensed.

Other funding.

• Clark County. Clark County Social Services contracts with adult day providers on a rolling basis. Applicants submit an application with their HCQC license and a business license, and county staff make an unannounced site visit. We could not read the county's contract scope of work, so ask the county about its standards.
• Veterans. We did not find Nevada-specific information on VA adult day health care. Veterans can ask their VA medical center.
• Older Americans Act and state aging funds. We did not find current ADSD adult day funding standards. Ask ADSD what is available in your area.

The market. We did not find a published count of licensed adult day centers in Nevada. HCQC offers a facility search but no total. We also did not find a Nevada adult day association.

What is changing next for adult day in Nevada?

State law now directs the Nevada Health Authority to set up a PACE program, but no launch date has been published. PACE (the Program of All-Inclusive Care for the Elderly) pays one organization a set monthly amount to cover all of a member's care, and PACE organizations usually run their own adult day center. Other recent changes are already in effect.

• PACE (announced, no date). NRS 422.3967, which replaced NRS 427A.255 in 2025, requires the Nevada Health Authority to establish and run a PACE program under federal PACE rules. As of our last check on October 21, 2026, we did not find a selected PACE organization or a start date from a state source. Watch for an announcement from the Nevada Health Authority.
• New licensing division (2025). A 2025 amendment to NRS 449.0032 names the Health Care Purchasing and Compliance Division of the Nevada Health Authority as the division that licenses health facilities, including adult day centers. The adult day regulations in NAC 449 still name the Division of Public and Behavioral Health and have not been updated. No date for that update was published.
• ADHC state plan update, effective October 1, 2025. A state plan amendment (NV-25-0035), approved by CMS on February 11, 2026, updated the 1915(i) ADHC benefit to reflect Nevada Medicaid's move into the Nevada Health Authority.
• Frail Elderly waiver renewed, July 1, 2025. The waiver that pays for social adult day care was renewed through June 30, 2030.

We did not find any announced change to adult day staffing, space rules or Medicaid adult day rates.

Nevada adult day sources

• Nevada Administrative Code Chapter 449 (adult day rules at NAC 449.4061 to 449.4089; fees at NAC 449.013)
• Nevada Revised Statutes Chapter 449 (licensing law)
• Nevada Bureau of Health Care Quality and Compliance (HCQC)
• Nevada Medicaid Services Manual Chapter 1800: 1915(i) Adult Day Health Care
• Nevada Medicaid Services Manual Chapter 2200: Frail Elderly Waiver
• Nevada Medicaid State Plan Attachment 3.1-i.1: 1915(i) benefit
• Frail Elderly Waiver renewal application (2025)
• Nevada Medicaid Provider Type 39 fee schedule (July 2026)
• Nevada Medicaid Provider Type 48 fee schedule (July 2026)
• Nevada Revised Statutes Chapter 422 (PACE, NRS 422.3967)

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Simplifying Payments with Electronic Billing for Adult Day Care
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Adult Day Care Activity Ideas to Keep Clients Engaged
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.