North Dakota Administrative Code

1. An individual employed by, or providing care in, a facility and any adult living in the facility, but not being provided care in the facility, may not have been found guilty of, pled guilty to, or pled no contest to: a. An offense described in North Dakota Century Code chapter…

1. Each member of the governing body of the applicant or agency, the chief executive officer, and any employees, volunteers, or agents who receive and disburse funds on behalf of the governing body, shall disclose to the department if they have been found guilty of, pled guilty t…

1. Three meals must be served daily. 2. Residents must be allowed access to food at any time and meal choices must be provided. Any restrictions on access to or choice of food because of health and safety concerns must be documented and justified in the person-centered service pl…

The provider shall furnish each prospective resident, or the resident's legal representative, and the department with a signed copy of the provider's lease or rental agreement prior to the resident entering the facility. A copy signed by the resident or legal representative and t…

1. Applicants shall submit, in a manner prescribed by the department, evidence that policies and procedures approved by the governing body are written and implemented in a manner that: a. Guarantees each resident a person-centered service plan; b. Guarantees the resident the righ…

1. The provider shall terminate care of a resident when care is no longer required or when the provider is no longer qualified to provide the care needed by the resident. 2. The provider who anticipates the termination of care to a resident shall provide the resident, or the resi…

The department may revoke or deny a license for any of the reasons permitted by law, or any combination of reasons. A revocation or denial based on one or more reasons must be affirmed, on appeal, if the evidence supports any reason given for revocation or denial. An agency that …

A copy of a notice of revocation or a notice of denial of a license application may be provided to any resident, any individual who resides in a place under circumstances which may require that place to be licensed as a facility for care of that individual, to any legal represent…

An agency or applicant whose license has been revoked or whose license application has been denied may not reapply, without the written permission of the department, until a final determination has been made with respect to the denial or revocation. History: Effective January 1, …

The following time periods are established for correction of deficiencies identified in a correction order: 1. For a deficiency that requires an agency to provide written documentation of qualifications in providing foster care for adults, a period of up to thirty days must be al…

An agency, if issued a notice of noncompliance with a correction order, must be assessed fiscal sanctions. 1. A violation of any of the following sections subjects the licensed provider to a fiscal sanction of twenty-five dollars per day--subsections 1 or 2 of section 75-03-21.1-…

The following records must be kept and maintained for each resident in the facility: 1. The resident's full name and birth date; 2. The name, address, and telephone number of the resident's legal representative when one exists and an emergency contact; 3. Names, addresses, and te…

1. An agency shall maintain program records, fiscal records, and supporting documentation, including: a. Authorization from the department for each resident for whom service is billed; b. Attendance sheets and other records documenting the days and times the residents received th…

The department shall conduct facility visits at the time of licensure, licensure renewal, or upon evidence of noncompliance. Monitoring visits at the time of licensure renewal or upon evidence of noncompliance must include home and community-based setting experience interviews wi…

Agencies and facilities licensed according to chapter 75-04-01 and North Dakota Century Code chapter 25-16 that provide residential habilitation services satisfy the requirements of section 75-03-21.1-11; sections 75-03-21.1-13 through 75-03-21.1-24; and sections 75-03-21.1-26, 7…

The terms used in this chapter have the same meaning as in North Dakota Century Code chapter 50-06.2. In addition, as used in this chapter: 1. "Activities of daily living" means the daily self-care personal activities that include bathing, dressing or undressing, eating or feedin…

1. An applicant must be entered in the SPED program pool before service payments may be authorized. The department shall allow entry into the SPED program pool to occur: a. When the department's designee submits a form in the manner prescribed by the department; or b. When the ap…

1. An individual transferred to SPED program active status from the SPED program pool shall continue to meet the eligibility criteria of section 75-03-23-02 in order to remain eligible for services funded under the SPED program. 2. The department is responsible for: a. Verifying …

An applicant is eligible to receive services funded by the Medicaid waiver program if: 1. The applicant is sixty-five years and older; or 2. The applicant is under age sixty-five with a congenital disability, a disability due to trauma, or a disability that is acquired and: 5 a. …

The department may not include room and board costs in the SPED service payment. The following categories of services are covered under the SPED program and may be provided to an eligible individual: 1. The department may provide adult day care services to an eligible individual:…

The department may not include room and board costs in the Medicaid waiver service payment. The following services are covered under the Medicaid waiver program and may be provided to an eligible individual: 1. The department may provide adult day care services to an eligible ind…

1. An individual or agency seeking designation as a qualified service provider shall complete and submit the applicable forms supplied by the department in the form and manner prescribed. 12 The qualified service provider, including any employees of an agency designated as a qual…

The department may deny an application to become a qualified service provider if: 1. The applicant voluntarily withdraws the application; 2. The applicant is not in compliance with applicable state laws, state regulations, or program issuances governing providers; 3. The applican…

1. The department may impose sanctions against a qualified service provider for any of the reasons listed under section 75-02-05-05 or subdivisions b though g of subsection 4. Prior to imposing sanctions, the department may require provider education or a business integrity agree…

1. The department shall establish provider rates for home and community-based service in accordance with a procedure that factors in: a. Whether a provider is an individual or an agency; and b. The range of rates submitted by various providers. 2. The rate for a specific qualifie…

A qualified service provider shall not submit a claim for payment or receive service payments for services that have not been delivered in accord with department policies and procedures. The department shall recover all payments received by a qualified service provider who fails …

1. The department or its designee shall inform an individual who is determined to be ineligible for covered services or who becomes ineligible while receiving services in writing of the denial, termination, or reduction, the reasons for the denial, termination, or reduction, the …

A qualified service provider may request a review of denial of payment in accordance with North Dakota Century Code section 50-24.1-24. History: Effective January 1, 2009; amended effective January 1, 2020. General Authority: NDCC 50-06.2-03, 50-24.1-24 Law Implemented: NDCC 50-0…

An applicant or provider may appeal a decision to deny or revoke a qualified service provider enrollment by filing a written appeal with the department within ten days of receipt of written notice of the denial or revocation. Upon receipt of a timely appeal, an administrative hea…

1. An individual is not eligible for SPED benefits under this chapter if the department determines that the individual or the spouse of the individual has made any assignment or transfer of any asset for the purpose of making the individual eligible for benefits before or after m…

1. An individual wishing to apply for benefits under this chapter must have the opportunity to do so, without delay. 2. An application is a request made to the department or its designee by an individual seeking services under this chapter, or by an individual properly seeking se…

A provider or applicant whose qualified service provider status has been terminated or denied may not reapply if: 23 1. The provider's or applicant's status as a qualified service provider has been denied or revoked within the twelve months prior to the date of the current applic…

1. An initial functional assessment, using the form required by the department, must be completed as a part of the application for benefits under this chapter. A functional assessment must be completed at least semiannually in conjunction with the eligibility redetermination. 2. …

1. "Community residence" means a private family home rented or owned by an individual or the individual's family, including an apartment, mobile home, licensed foster home for adults as defined in North Dakota Century Code section 50-11-00.1, or agency foster home for adults as d…

To be eligible for target population member rental assistance, the applicant shall: 1. Be twenty-one years or older; 2. Have twenty-five thousand dollars or less in assets; 3. Be receiving Medicaid, have applied for Medicaid, or be receiving service payments for the elderly and d…

1. The department may provide target population member rental assistance to an eligible individual to cover the rental funding gap for an eligible individual until a federal rental subsidy is obtained for the individual. 2. The department shall review the amount of the target pop…

1. The department shall inform an individual who is determined to be ineligible for the target population member rental assistance program or who becomes ineligible while receiving assistance or services from the target population member rental assistance program in writing of th…

1. "Community residence" means a private family home rented or owned by an individual or the individuals family, including an apartment, mobile home, foster home for adults as defined in North Dakota Century Code section 50-11-00.1, or agency foster home for adults as defined in …

1. To be considered eligible for community transition, an applicant of any age must: a. Be receiving Medicaid and have a significant disability; b. Be receiving Medicaid expansion, have a significant disability, and have a verifiable monthly income at or below one hundred thirty-…

1. To be considered eligible for the diversion program, an applicant, of any age must: a. Be receiving Medicaid and have a significant disability; b. Be receiving Medicaid expansion, have a significant disability, and have a verifiable monthly income at or below one hundred thirt…

Programmatic criteria. 1. The department may provide community transition and diversion services necessary for: 3 a. A successful transition from a provider-operated residential facility, foster home for adults as defined in North Dakota Century Code section 50-11-00.1, agency fo…

1. As part of the community transition and diversion program, the department may provide the following one-time products and services necessary for community transition or diversion: a. Health and safety-related technology or expenses; b. Security deposits required to obtain a le…

1. The department shall inform an individual who is determined to be ineligible for the community transition and diversion program or who becomes ineligible while participating in the community transition and division program in writing of the denial, termination, or reduction, t…

For purposes of this chapter, unless the context requires otherwise: 1. "Activities of daily living" means bathing, dressing, toileting, transferring, eating, bed mobility, medication management, and personal hygiene. 2. "Blind" has the same meaning as the term has when used by t…

An individual may receive necessary benefits under this chapter if the individual: 1. Is a resident of this state; 2. Is: 1 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 ben…

1. The department is responsible for: a. Verifying that the individual transferred to active status continues to meet the eligibility criteria for placement into the ex-SPED program pool; b. Developing a care plan; c. Authorizing covered services in accordance with department pol…

1. All individuals wishing to make application for benefits under this chapter must have the opportunity to do so, without delay. 2. An application is a request made by an individual desiring benefits under this chapter, or by a proper individual seeking such benefits on behalf o…

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…

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…

Room and board costs may not be paid in the ex-SPED service payment. The following categories of services are covered under the ex-SPED program and may be provided to an eligible individual: 1. The department may provide adult day care services to an eligible individual: a. Who r…