North Dakota Administrative Code

1. Except as provided in subsection 4, costs applicable to services, facilities, and supplies furnished to a provider by a related organization may not exceed the lower of the cost to the related organization or the price of comparable services, facilities, or supplies purchased …

1. Compensation on an annual basis for top management personnel must be limited, prior to allocation, if any, to the greatest of: a. The highest market-driven compensation of an administrator employed by a freestanding not-for-profit facility during the previous report year incre…

1. Ratesetting principles require that payment for services include depreciation on all capital assets used to provide necessary services. a. Capital assets that may have been fully or partially depreciated on the books of the provider, but are in use at the time the provider ent…

1. To be allowable, interest expense must meet all of the following criteria: a. Interest expense must be supported by evidence of an agreement that funds were borrowed and that payment of interest and repayment of the funds is required. b. Interest expense must be identifiable i…

1. Taxes assessed against the provider, in accordance with the levying enactments of the several states and lower levels of government and for which the provider is liable for payment, are allowable costs. Tax expense may not include fines, penalties, or those taxes identified as…

In the first stages of operation, a new facility incurs certain costs in developing its ability to care for residents prior to admission. Staff is obtained and organized, and other operating costs are incurred during this time of preparation that cannot be allocated to resident c…

1. Funding of depreciation is the practice of placing funds, including nonborrowed bond reserve and sinking funds, in a segregated account for the acquisition of capital assets used in rendering resident care or for other capital purposes related to resident care. Other capital p…

1. For each cost category, the actual rate is calculated using allowable historical operating costs plus adjustment factors provided for in section 75-02-07.1-21 for the direct care, indirect care, and food and plant cost categories, divided by in-house resident days for the dire…

1. The adjustment factor must be applied to adjust historical costs. The adjustment factor must be used to adjust direct care, indirect care, and food and plant costs, exclusive of bad debt expense. 2. Historical costs must be adjusted to December thirty-first of a report year us…

Historical costs, as adjusted, for all facilities for which a rate is established excluding specialized facilities for individuals with mental disease, must be used in the establishment of a limit rate for the direct care and indirect care cost categories. The actual rate for eac…

1. Desk audit rate. a. The cost report must be reviewed taking into consideration the prior year's adjustments. The facility must be notified by telephone or electronic mail of any adjustments based on the desk review. Within seven working days after notification, the facility ma…

1. The established rate must be considered as payment for all accommodations and includes all items includable as allowable under this chapter for an eligible beneficiary. No payment may be solicited or received from the eligible beneficiary or any other person to supplement the …

1. For a new facility, the department shall establish an interim rate equal to the lesser of the limit rates for direct and indirect care for the rate year in which the facility begins operation, plus the maximum operating margin, plus a room and board rate equal to the average f…

1. Adjustments to meet licensure standards. a. The department may provide for an increase in the established rate for additional costs incurred to meet licensure standards. The survey conducted by the department's public health division must clearly require that the facility take…

Under no circumstances, including an appeal or judicial decision to the effect that a rate was erroneously established, may a rate adjustment be made unless the cumulative impact of adjustments equals or exceeds twenty-five cents per day. History: Effective July 1, 1996; amended …

The department shall notify each facility of the desk audit rate on or before May twenty-first of the year in which the rate year begins. History: Effective July 1, 1996. General Authority: NDCC 50-06-16, 50-24.5-02(3) Law Implemented: NDCC 50-24.5-02(3)

1. Reconsiderations. a. Any requests for reconsideration of the final rate must be filed with the department within thirty days of the date of the rate notification. b. A request for reconsideration must include: (1) A statement of each disputed item and the reason or basis for t…

1. A facility may not require a resident to deposit personal funds with the facility. 2. Upon written authorization of a resident or the resident's legal representative, a facility shall hold, safeguard, manage, and account for the resident's personal funds deposited with the fac…

1. "Accrual basis" means the recording of revenue in the period when it is earned, regardless of when it is collected, and the recording of expenses in the period when incurred, regardless of when they are paid. 2. "Adjustment factor" means the legislatively approved inflation ra…

1. Records. a. The facility shall maintain on the premises census records and financial information sufficient to provide for a proper audit or review. For any cost being claimed on the cost report, sufficient data must be available as of the audit date to fully support the repor…

1. For ratesetting purposes, a cost must: a. Be ordinary, necessary, and related to resident care; b. Be no more than an amount a prudent and cost-conscious business person would pay for the specific good or service in the open market in an arm's-length transaction; and c. Be for…

1. The established rate is based on prospective ratesetting procedures. The establishment of a rate begins with historical costs. Adjustments are then made for claimed costs not includable in allowable costs. Adjustment factors are then applied to allowable costs. Retroactive set…

1. A daily census record must be maintained by the facility. Any day services provided or for which payment is ordinarily sought for an available bed must be counted as a resident day. The day of admission and day of death are resident days. The day of discharge must be counted i…

1. Administration costs are the allowable costs of activities performed by the staff in which the direct recipient of the activity is the organization itself, including fiscal activities, statistical reporting, recruiting, and general office management indirectly related to reimb…

1. Direct costing of allowable facility costs must be used whenever possible. If direct costing is not possible, the allocation methods for facility and nonfacility operations described in this subsection must be used. a. Salaries for direct care employees, which cannot be report…

Nonallowable costs include: 1. Promotional, publicity, and advertising expenses, exclusive of personnel procurement; 2. Political contributions; 3. Salaries or expenses of a lobbyist; 4. Basic research; 5. Fines or penalties including interest charges on the penalty, bank overdra…

1. Ratesetting principles require that payment for services should include depreciation on all depreciable type assets used to provide necessary services. This includes assets that may have been fully or partially depreciated on the books of the facility, but are in use at the ti…

1. To be allowable under the program, interest must be: a. Supported by evidence of an agreement that funds were borrowed and that payment of interest and repayment of the funds are required. Repayment of operating loans must be made within two years of the borrowing; b. Identifi…

incurred during the construction of an asset must be capitalized as a part of the cost of the asset. b. All repair or maintenance costs in excess of five thousand dollars per project on equipment or buildings must be capitalized and depreciated over the remaining useful life of t…

1. Home offices of chain organizations vary greatly in size, number of locations, staff, mode of operations, and services furnished to their member facilities. Although the home office of a chain is normally not a facility in itself, it may furnish to the individual facility cent…

1. Costs applicable to services, buildings, equipment, and supplies furnished to a facility by a related organization may not exceed the lower of the costs to the related organization or the price of comparable services, buildings, equipment, or supplies purchased elsewhere prima…

In the first stages of operation, a new facility incurs certain costs in developing its ability to care for residents prior to their admission. Staff is obtained and organized, and other operating costs are incurred during this time of preparation which cannot be allocated to res…

Reasonable compensation for an individual with a minimum of five percent ownership, individuals on the governing board, or family members of top management personnel, including spouses and individuals in the following relationship to top management personnel or their spouses: par…

A facility must identify income to offset facility costs when applicable so state financial participation does not supplant or duplicate other funding sources. Any income whether in cash or in any other form received by the facility, with the exception of the established rate, in…

1. The medical assistance rate may not exceed the rate charged to nonmedical assistance residents for the same service. The rate being charged nonmedical assistance residents at the time the services are provided will govern. In cases where the residents are not charged a daily r…

1. Reconsiderations. a. A facility dissatisfied with the final rate established must request a reconsideration of the final rate before a formal appeal may be made. Any requests for reconsideration must be filed with the department's medical services division within thirty days o…

1. A facility shall have an effective provider agreement with the department. 2. A facility may charge to hold a bed for a period in excess of the period covered under subsection 3 of section 75-02-09-05, if: a. The resident, or a person acting on behalf of the resident, has requ…

The terms used in this chapter have the same meaning as in North Dakota Century Code chapter 50-24.5. In addition, for purposes of this chapter, unless the context requires otherwise: 1. "Activities of daily living" means bathing, dressing, toileting, transferring, eating, bed mo…

To the extent that an eligible individual lacks income sufficient to meet the cost of necessary benefits, the following benefits are available: 1. Supplementation of the income of users of basic care services; 2. Case management; 3. Other services the department determines to be …

1. a. All individuals wishing to make application for benefits under this chapter must have the opportunity to do so, without delay. b. An application is a request made by an individual desiring benefits under this chapter, or by a proper individual seeking such benefits on behal…

The applicant or guardian of the applicant shall provide information sufficient to establish eligibility for benefits, including a social security number and proof of age, identity, residence, blindness, disability, functional limitation, financial eligibility, and such other inf…

An individual may receive necessary benefits under this chapter if the individual: 1. Is a resident of this state; 2. Is: a. Sixty-five years of age or older; or b. Eighteen years of age or older and disabled or blind; 3. Has applied for and been found eligible for Medicaid benef…

1. For purposes of this section, "functional assessment" means an instrument used to record basic demographic and medical information about an individual, including age, date of birth, spoken language, marital status, individuals residing with, emergency contacts, medical resourc…

Repealed effective April 1, 2012.

1. A decision as to eligibility will be made promptly on applications, usually within forty-five days, except in unusual circumstances. 2. A decision as to eligibility on a redetermination will be made within thirty days. 3. Immediately upon an eligibility determination, whether …

1. a. Except as provided in subsection 2, an individual is ineligible for benefits under this chapter if the individual or the spouse of the individual disposes of assets or income for less than fair market value on or after the look-back date specified in subdivision b. b. The l…

For purposes of this chapter: 1. An individual is a resident of this state if: a. The individual is not living in an institution and is living in this state: (1) With intent to remain in this state permanently or for an indefinite period; or (2) Without intent if the individual i…