Title 50, Public Welfare

Payment rates paid to any nursing home receiving medical assistance payments must be those rates established pursuant to this chapter and rules adopted under it.

No medical assistance payments may be made to any nursing home unless the nursing home is certified to participate in the medical assistance program under title XIX of the federal Social Security Act and has in effect a provider agreement with the department meeting the requireme…

1. The department shall determine prospective payment rates for resident care costs. The department shall develop procedures for determining operating cost payment rates that take into account the mix of resident needs and other factors as determined by the department. 2. The dep…

1. The following costs may not be recognized as allowable: political contributions; salaries or expenses of a lobbyist, as defined in section 54-05.1-02, for lobbying activities; advertising designed to encourage potential residents to select a particular nursing home; fines and …

No increase in nursing home rates for private-paying residents is effective unless the nursing home notifies the resident or person responsible for payment of the increase in writing thirty days before the increase takes effect. A nursing home may adjust its rates without giving …

1. The department shall establish procedures for determining per diem reimbursement for operating costs. 2. The department shall analyze and evaluate each nursing home's cost report of allowable operating costs incurred by the nursing home during the reporting year immediately pr…

1. The department may allow a one-time adjustment to historical operating costs of a nursing home that has been found by the department to be significantly below care-related minimum standards appropriate to the mix of resident needs in that nursing home when it is determined by …

If the department learns that expenditures for direct resident care have been reduced in amounts large enough to indicate a possible detrimental effect on the quality of care, the licensing division shall be notified.

Until procedures for determining operating cost payment rates according to mix of resident needs are established for nursing homes that exclusively provide residential services for nongeriatric individuals with physical disabilities or units within nursing homes which exclusively…

All general and administrative costs must be included in general and administrative costs in total, without direct or indirect allocation to other cost categories. In a nursing home of sixty or fewer beds, part of an administrator's salary may be allocated to other cost categorie…

1. The department shall include in the ratesetting system for nursing homes a fair rental value payment mechanism for the use of real and personal property. 2. The department shall establish a per bed property cost limitation considering single and double occupancy construction. …

1. For nursing homes with a significant capacity increase and for newly constructed nursing homes, which first provide services on or after July 1, 1988, and which are not included in the calculation of the limits of any cost category, the department shall establish procedures fo…

1. Rate adjustments may be made to correct errors subsequently determined and must also be retroactive to the beginning of the facility's rate year except with respect to rates paid by private-paying residents. 2. Any requests for reconsideration of the rate must be filed with th…

1. A nursing home dissatisfied with the final rate established may, upon completion of the reconsideration, appeal. An appeal may be perfected by mailing or delivering the information described in subdivisions a through e to the department, at such address as the department may d…

1. For purposes of this section: a. "Final decision rate" means the amount, if any, determined on a per day basis, by which a rate otherwise set under this chapter is increased as a result of a request for reconsideration made under section 50-24.4-17, a request for an administra…

A nursing home is not eligible to receive medical assistance payments unless it refrains from all of the following: 1. Charging private-paying residents rates for similar services which exceed those rates which are approved by the department for medical assistance recipients, as …

1. Notwithstanding section 50-24.4-19, a nursing home may receive a payment, in addition to payment of the rate set under this chapter, for the use of a private room by a resident who receives medical assistance benefits if: a. The private room is not medically necessary; b. The …

The department shall develop criteria identifying extraordinary medical needs so severe as to make it difficult for affected persons to secure necessary care in nursing facilities. The department shall consider those extraordinary medical needs that may be associated with extensi…

For a period not to exceed one hundred eighty days from the date of mailing formal notice, the department may continue to make medical assistance payments to a nursing home which is in violation of this chapter if extreme hardship to the residents would otherwise result. In these…

If a nursing home terminates its participation in the medical assistance program, whether voluntarily or involuntarily, the department may authorize the nursing home to receive continued reimbursement only on a temporary basis until medical assistance residents can be relocated t…

In the event that the state is determined by the federal government to be no longer eligible for the federal share of medical assistance payments made to a nursing home under this chapter, the department may cease medical assistance payments to that nursing home.

1. No later than October first of each year, each nursing home that receives medical assistance payments from the department shall: a. Except for state-owned facilities, provide the department with a copy of its audited report that meets the reporting standards of the American in…

The department may reject any annual cost report filed by a nursing home pursuant to this chapter if the department determines that the report or the information required in section 50-24.4-23 has been filed in a form that is incomplete or inaccurate. In the event that a report i…

The department may grant an extension of the reporting deadline, not to exceed thirty days, to a nursing home for good cause.

If a nursing home knowingly supplies inaccurate or false information in a required report that results in an overpayment, the department shall: 1. Immediately adjust the nursing home's payment rate to recover the entire overpayment within the rate year; 2. Terminate the departmen…

All nursing facilities certified under the medical assistance program shall participate in Medicare part A and part B with respect to at least thirty percent of the beds in the facility unless, after submitting an application, Medicare certification is denied by the federal healt…

The department shall seek appropriations to implement this chapter during and after the rate year beginning January 1, 1990.

The department may select skilled nursing facilities within the state to operate a unit that provides geropsychiatric services. Admission to one of the skilled nursing facilities that provides geropsychiatric services may be granted only after an individual practicing within the …