Title 50, Public Welfare

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 …

In this chapter, unless the context otherwise requires: 1. "Adult residential facility" means a licensed basic care facility that meets the program and provider requirements of the Medicaid 1915(c) home and community-based services aged and disabled waiver, specializing in the ca…

The department shall: 1. Administer aid to vulnerable aged, blind, and disabled persons and supervise and direct human service zones in the administration of aid to vulnerable aged, blind, and disabled persons. 2. Supplement, within the limits of legislative appropriation, the in…

The department shall allow a basic care facility to charge a higher rate for a private room used by a recipient of benefits under this chapter if the private room is not necessary to meet the resident's care needs; the resident, or a person acting on behalf of the resident, has r…

1. The department shall determine limits for the care of residents of basic care facilities that qualify as vendors of an aged, blind, and disabled persons program and for implementing provisions of this chapter based on data demonstrating the most recent costs that must be incur…

1. The department shall require an adult residential facility to submit cost reports and supplemental information by October 31, 2025, which the department shall use to pay the facility its current costs beginning January 1, 2026. 2. The department shall require adult residential…

Each human service zone, unless otherwise directed or determined by the department, shall: 1. Administer aid to aged, blind, and disabled persons at the human service zone level under the direction and supervision of the department, pursuant to state requirements. 2. Provide the …

Services provided under this chapter must be treated as necessary remedial care to the extent those services are not covered under the medical assistance program. The cost of the services provided under this chapter to a person residing in a basic care facility for which the rate…

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, and financial eligibility for each month …

For purposes of this chapter: 1. A person is a resident of this state if: a. The person 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 person is incapable o…

Funds used to provide services to an eligible beneficiary may not be considered as gifts. The department has a preferred claim against the estate of any person for recovery of funds expended under this chapter for that person or that person's spouse or minor children. No statute …

Expenditures required under this chapter are the responsibility of the state of North Dakota.

Notwithstanding the requirements of subsection 2 of section 28-32-03, the department has the authority to create emergency rules related to the compensation for top management personnel of a basic care facility combined with a hospital.

As used in this chapter, unless the context otherwise requires: 1. "Board" means the drug use review board. 2. "Compendium" means the American hospital formulary service drug information, United States pharmacopeia-drug information, the DRUGDEX information system, American medica…

1. The board is established within the department for the implementation of a drug use review program. 2. The board consists of seventeen members. The pharmacy administrator of the department and the medical consultant to the department are ex officio nonvoting board members who …

The board shall: 1. Cooperate with the department to create and implement a prospective and retrospective drug use review program for outpatient prescription drugs under the medical assistance program. This drug use review program must be based on a compendium and drug use review…

1. The department shall develop and implement a prior authorization program that meets the requirements of 42 U.S.C. 1396r-8(d) to determine coverage of drug products when a medical assistance recipient's health care provider prescribes a drug that is identified as requiring prio…

1. The department shall provide thirty days' notice of all meetings of the board. The notice requirement is met if the department provides notice of the meeting on the department's website and provides, by written or electronic means, individual notice to each person that has req…

A medical assistance recipient who is aggrieved by the placement of a drug on prior authorization may appeal as authorized under chapter 28-32.

The department may not offer or pay, directly or indirectly, any material inducement, bonus, or other financial incentive to a participating provider based on the denial or delay of medically necessary and appropriate prescription drug therapy or based on a reduction in the propo…

1. To promote efficiency and savings in the department's service to eligible medical assistance program recipients, the department shall create and implement the broadest possible list of drugs that can be paid at the maximum allowable costs. To further promote efficiency and sav…

The department shall adopt rules to implement this chapter.

In this chapter, unless the context otherwise requires: 1. "Aged" means at least sixty-five years of age. 2. "Blind" has the same meaning as the term has when used by the social security administration in the supplemental security income program under titles II and XVI of the Soc…

1. The department shall administer expanded service payments for elderly and disabled and supervise and direct human service zones in the administration of expanded service payments for elderly and disabled. 2. The department shall pay qualified service providers at rates determi…

Each human service zone, unless otherwise directed or determined by the department, shall: 1. Administer expanded service payments for elderly and disabled at the human service zone level under the direction and supervision of the department, pursuant to state requirements. 2. Pr…

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, and financial eligibility for each month …

Funds used to provide services to an eligible beneficiary may not be considered as gifts. The department has a preferred claim against the estate of any person for recovery of funds expended under this chapter for that person or that person's spouse or minor children. No statute …

Expenditures required under this chapter are the responsibility of the state of North Dakota.

The department may establish an intensive care coordination pilot project under the home and community-based service options for older adults and individuals with physical disabilities.

As used in this chapter, unless the context otherwise requires: 1. "Benefit" means the provision of anything of pecuniary value under the Medicaid program. 2. "Claim" means: a. Any request or demand, whether under a contract or otherwise, for money or property under the Medicaid …