reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-07 - Related organization

Current through Supplement No. 393, July, 2024
1. Except as
				provided in subsection 3, 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 elsewhere primarily in the local
				market. The provider shall identify the related organizations and costs in the
				cost report.
2. The relationship
				between a provider and a related organization at the time a transaction between
				the two parties occurs must govern the treatment of cost regardless of
				subsequent events that may change the relationship between the parties.
3. In the case of a facility
				acquired through purchase of shares, interest and depreciation expense are
				treated in the same manner as if the capital assets of the acquired corporation
				were acquired as an ongoing operation by the acquiring entity on the day the
				secretary of state issues a certificate of dissolution of the acquired
				corporation if organized in North Dakota, or on the day the acquired
				corporation is irrevocably dissolved if organized other than in North Dakota,
				provided the transaction has all of the following characteristics:
a. The facility was owned and operated by the
				acquired corporation;
b. The
				acquired corporation is irrevocably dissolved, and all of its capital assets
				become the property of the acquiring entity, within one year after the first
				day on which any ownership interest in the acquired corporation was acquired by
				the acquiring entity; and
c.
				Neither the acquiring entity nor any related organization of the acquiring
				entity has had any ownership interest in the acquired corporation, or any
				ownership interest in any related organization of the acquired corporation, for
				at least ten years prior to the day the acquiring entity, or a related
				organization of the acquiring entity, first acquired any ownership interest in
				the acquired corporation.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-08 - Rental expense paid to a related organization

Current through Supplement No. 393, July, 2024
A provider may lease a facility from a related organization
				  within the meaning of ratesetting principles. In such case, the rent paid to
				  the lessor by the provider is not allowable as cost unless the rent paid is
				  less than the allowable costs of ownership. If rent paid exceeds the allowable
				  costs of ownership, the provider may include the allowable costs of ownership
				  of the facility. These costs are property insurance, depreciation, interest on
				  the mortgage, and real estate taxes. Other operating expenses of the related
				  organization are not includable by the provider as an allowable cost of
				  ownership, but may be included as allowable operating expenses subject to the
				  provisions of section
				  75-02-06-07.
General Authority: NDCC
					 50-24.1-04,
					 50-24.4-02
Law Implemented: NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-09 - Taxes

Current through Supplement No. 393, July, 2024
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 nonallowable costs in section
				75-02-06-12.1.
2. Whenever exemptions to taxes are legally
				available the provider is to take advantage of them. If the provider does not
				take advantage of available exemptions, the expense incurred for taxes is not
				an allowable cost.
3. Special
				assessments in excess of one thousand dollars paid in a lump sum must be
				capitalized and depreciated. Special assessments not paid in a lump sum may be
				expensed as billed by the taxing authority.
General Authority: NDCC
					 50-24.1-04,
					 50-24.4-02
Law Implemented: NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-10 - Bad debts

Current through Supplement No. 393, July, 2024
1. Bad debts for
				charges incurred on or after January 1, 1990, and fees paid for the collection
				of those bad debts, are allowable, provided all the requirements of this
				subsection are met.
a. The bad debt must
				result from nonpayment of the payment rate or part of the payment
				rate.
b. The facility shall
				document that reasonable collection efforts have been made, the debt was
				uncollectible, and there is no likelihood of future recovery. Reasonable
				collection efforts include pursuing all avenues of collection available to the
				facility, including liens and judgments. In instances where the bad debt is
				owed by a person determined to have made a disqualifying transfer or assignment
				of property for the purpose of securing eligibility for medical assistance
				benefits, the facility shall document that it has made all reasonable efforts
				to secure payment from the transferee, including the bringing of an action for
				a transfer in fraud of creditors.
c. The collection fee may not exceed industry
				standards for collection agencies and the amount of the bad debt.
d. The bad debt may not result from the
				facility's failure to comply with federal and state laws, state rules, and
				federal regulations.
e. The bad
				debt may not result from nonpayment of a private room rate in excess of the
				established rate, charges for special services not included in the established
				rate, or charges for bed hold days not billable to the medical assistance
				program under subsections 3, 4, 5, and 6 of section
				75-02-06-14.
f. The facility shall have an aggressive
				policy of avoiding bad debt expense that limits potential bad debts. The
				facility shall document that the facility has taken action to limit bad debts
				for individuals who refuse to make payment.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-11 - Startup costs

Current through Supplement No. 393, July, 2024
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 which cannot be allocated to resident
				  care during that period because there are no residents receiving services.
				  These costs are commonly referred to as startup costs. Actual allowable startup
				  costs may be considered as deferred charges and allocated over a number of
				  periods which benefit from such costs. Where a facility has properly
				  capitalized startup costs as a deferred charge, the startup costs will be
				  recognized as allowable costs amortized over sixty consecutive months starting
				  with the month in which the first resident is admitted.
General Authority: NDCC
					 50-24.1-04,
					 50-24.4-02
Law Implemented: NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-12 - Offsets to cost

Current through Supplement No. 393, July, 2024
1. Several items of
				income must be considered as offsets against various costs as recorded in the
				books of the facility. Income in any form received by the facility must be
				offset up to the total of the appropriate actual allowable costs, with the
				following exceptions:
a. An established
				rate;
b. Income from payments made
				under the Workforce Investment Act;
c. Bed reduction incentive
				payments;
d. Donations;
e. The deferred portion of patronage
				dividends credited to the facility and not previously offset;
f. Charges for private rooms or special
				services;
g. Noncovered bed hold
				days; or
h. Sales tax revenue
				received from a political subdivision or local taxing authority for a facility
				located in a community with a population of less than twelve thousand five
				hundred people.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-14 - Resident days

Current through Supplement No. 393, July, 2024
1. A resident day
				is any day for which service is provided or for which payment is ordinarily
				sought for use of a bed. The amount of remuneration has no bearing on whether a
				day should be counted.
2. Adequate
				census records must be prepared and maintained on a daily basis by the facility
				to allow for proper audit of the census data. The daily census records must
				include:
a. Identification of the
				resident;
b. Entries for all days,
				and not just by exception;
c.
				Identification of type of day, i.e., hospital, in-house;
d. Identification of the resident's
				classification; and
e. Monthly
				totals by resident, by classifications for all residents, and by type of
				day.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-16 - Rate determinations for cost

Current through Supplement No. 393, July, 2024
1. This
				section is applicable for establishing a cost rate for direct care, other
				direct care, and indirect care for the June 30, 2021, report year.
2. Rate determination.
a. For the direct cost category, the actual
				rate is calculated using allowable historical operating costs and adjustment
				factors provided for in subsection 5 divided by standardized resident days. The
				actual rate as calculated is compared to the limit rate to determine the lesser
				of the actual rate or the limit rate. The lesser rate is given the rate weight
				of one. The rate weight of one for direct care is then multiplied times the
				weight for each classification in subsection 5 of section
				75-02-06-17 to establish the
				direct care rate for that classification.
b. For the other direct cost category, the
				actual rate is calculated using allowable historical operating costs and
				adjustment factors provided for in subsection 4 divided by resident days. The
				actual rate as calculated is compared to the limit rate to determine the lesser
				of the actual rate or the limit rate.
c. For the indirect cost category, the actual
				rate is calculated using allowable historical operating costs and adjustment
				factors provided for in subsection 4 divided by resident days subject to the
				adjustments provided for in subdivision g of subsection 4. The actual rate as
				calculated is compared to the limit rate to determine the lesser of the actual
				rate or the limit rate.
d. For the
				passthrough costs category, the actual rate is calculated using allowable
				historical operating costs divided by resident days subject to the adjustments
				provided for in subdivision g of subsection 4.
e. The property rate must be the greater of
				the fair rental value rate or the rate calculated using allowable property
				costs. The property rate must be calculated using resident days subject to the
				adjustments provided for in subdivision g of subsection 4. The fair rental
				value rate must be the rate established under subdivision e of subsection 1 of
				section 75-02-06-16.3.
f. The lesser of the actual rate or the limit
				rate for other direct care and indirect care, the passthrough rate, the
				property rate, and the adjustments provided for in subsections 3 and 4 are then
				added to the direct care rate for each classification to arrive at the
				established rate for a given classification.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-16.2 - One-time adjustments for legislatively approved cost increases

Current through Supplement No. 393, July, 2024
1. The department
				shall increase rates otherwise established by this chapter for supplemental
				payments or one-time adjustments to historical costs approved by the
				legislative assembly.
2. Any
				additional funds made available by the supplemental payments or one-time
				adjustments must be used for the legislatively prescribed purpose and are
				subject to audit. If the department determines that the funds were not used for
				the appropriate purpose, an adjustment must be made in accordance with
				subsection 6 of section 75-02-06-16.
General Authority:
NDCC 50-24.1-04,
					 50-24.4-02
Law Implemented:
NDCC
					 50-24.4
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-16.3 - Rate determinations for price

Current through Supplement No. 393, July, 2024
1.
				Rate determination.
a. For the direct cost
				category, the actual rate is calculated using allowable historical operating
				costs and adjustment factors provided for in subsection 4 divided by
				standardized resident days. The actual rate must include the margin cap. The
				actual rate as calculated is compared to the price rate to determine the lesser
				of the actual rate or the price rate. The lesser rate is given the rate weight
				of one. The rate weight of one for direct care is then multiplied times the
				weight for each classification in subsection 5 of section
				75-02-06-17 to establish the
				direct care rate for that classification.
b. For the other direct cost category, the
				actual rate is calculated using allowable historical operating costs and
				adjustment factors provided for in subsection 5 divided by resident days. The
				actual rate must include the margin cap. The actual rate as calculated is
				compared to the price rate to determine the lesser of the actual rate or the
				price rate.
c. For the indirect
				cost category, the actual rate is calculated using allowable historical
				operating costs and adjustment factors provided for in subsection 5 divided by
				resident days subject to the adjustments provided for in subdivision i of
				subsection 3. The actual rate must include the margin cap. The actual rate as
				calculated is compared to the price rate to determine the lesser of the actual
				rate or the price rate.
d. For the
				passthrough costs category, the actual rate is calculated using allowable
				historical operating costs divided by resident days subject to the adjustments
				provided for in subdivision i of subsection 3.
e. The property rate must be the greater of
				the fair rental value rate or the rate calculated using allowable property
				costs subject to subsection 2. The property rate must be calculated using
				resident days subject to the adjustments provided for in subdivision i of
				subsection 3.
f. The lesser of the
				actual rate or the price rate for other direct care and indirect care, the
				passthrough rate, the property rate, and the adjustments provided for in
				subsection 3 are then added to the direct care rate for each classification to
				arrive at the established rate for a given classification.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-17 - Classifications

Current through Supplement No. 393, July, 2024
1. A facility shall complete a resident
				assessment for any resident occupying a licensed facility bed, except a respite
				care, hospice inpatient respite care, or hospice general care
				resident.
2. A resident must be
				classified in one of forty-eight classifications based on the resident
				assessment. If a resident assessment is not performed in accordance with
				subsection 3, except for a respite care, hospice inpatient respite care, or
				hospice general inpatient care resident, the resident must be included in group
				AAA, not classified, until the next required resident assessment is performed
				in accordance with subsection 3. For purposes of determining standardized
				resident days, any resident day classified as group AAA must be assigned the
				relative weight of one. A resident, except for a respite care, hospice
				inpatient respite care, or hospice general inpatient care resident, who has not
				been classified, must be billed at the group AAA established rate. The case-mix
				weight for establishing the rate for group AAA is 0.45. Days for a respite
				care, hospice inpatient respite care, or hospice general inpatient care
				resident who is not classified must be given a weight of one when determining
				standardized resident days. Therapeutic, hospital, or institutional leave days
				that are resident days must be given a weight of 0.45 when determining
				standardized resident days.
3.
				Resident assessments must be completed as follows:
a. The facility shall assess the resident
				within the first fourteen days after any admission or return from an acute
				hospital stay. The assessment reference date must be between day seven and day
				fourteen.
b. The facility shall
				assess the resident quarterly after any admission or return from an acute
				hospital stay. The quarterly assessment reference period ends on the day of the
				third subsequent month corresponding to the day of admission or return from an
				acute hospital stay, except if that month does not have a corresponding date,
				the quarterly assessment reference period ends on the first day of the next
				month. The assessment reference period begins seven days prior to the ending
				date of a quarterly assessment period. The assessment reference date used for
				the resident assessment instrument must be within the assessment reference
				period.
c. An assessment must be
				submitted upon initiation of rehabilitation therapy if initiation of
				rehabilitation therapy occurs outside of the quarterly assessment reference
				period established in subdivision b.
d. An assessment must be submitted upon
				discontinuation of rehabilitation therapy if discontinuation of rehabilitation
				therapy occurs outside of the quarterly assessment reference period established
				in subdivision b.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-20 - Resident personal funds

Current through Supplement No. 393, July, 2024
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 facility.
3. A
				facility may not charge the resident for holding, safeguarding, managing, or
				accounting for the resident's personal funds. Any related administrative costs,
				including bank charges, must be included in the daily rate. A facility may not
				impose a charge against a resident's personal funds for any item or service
				included in the daily rate.
4. A
				facility may maintain a resident's personal funds that do not exceed fifty
				dollars in a noninterest-bearing account. A facility shall deposit any
				resident's personal funds in excess of fifty dollars in an interest-bearing
				account that is separate from any of the facility's accounts and that credits
				all interest earned on the resident's account to the account.
5. A facility shall maintain a system that
				ensures a full, complete, and separate accounting, according to generally
				accepted accounting principles, of each resident's personal funds. An
				individual financial record must be available on request and a written
				accounting of transactions must be provided quarterly to the resident or the
				resident's legal representative.
6. A resident's personal funds may not be
				commingled with any facility funds or with funds of any person other than
				another resident.
7. Upon death of
				a resident, the facility shall promptly convey the resident's personal funds,
				and a final accounting of those funds, to the individual administering the
				resident's estate. For purposes of this section, an "individual administering
				the resident's estate" includes a person lawfully empowered to facilitate the
				transfer of small estates without the use of a personal representative.
8. A facility shall purchase a
				surety bond or provide self-insurance to ensure the security of all resident
				personal funds deposited with the facility.
General Authority: NDCC
					 50-24.1-04,
					 50-24.4-02
Law Implemented: NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-21 - Specialized rates for extraordinary medical care

Current through Supplement No. 393, July, 2024
1. A specialized rate for an individual with
				extraordinary medical needs may be established if the criteria in both
				subdivisions a and b are met.
a.
(1) The individual requires specialized
				therapies that are:
(a) Restorative in nature
				(restorative means the individual has the ability to improve);
(b) Medically necessary and provided in the
				facility;
(c) Of at least two
				different types; and
(d) Provided
				in excess of fifteen hours per week;
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-22 - Participation requirement

Current through Supplement No. 393, July, 2024
A facility must comply with the following provisions in order
				  to be eligible to receive medical assistance payments.
1. A facility may not charge private-pay
				residents rates that exceed those rates approved by the department for medical
				assistance recipients, except that:
a. A
				facility may charge a higher rate for a private room.
b. A facility may charge for special services
				not included in the daily rate if medical assistance residents are charged
				separately at the same rate for the same services. Special services must be
				available to all residents and residents must be free to select or decline the
				special services. Special services may not include services provided by the
				facility in order to comply with licensure or certification standards which, if
				not provided, would result in a deficiency or violation by the facility.
				Services beyond those required to comply with licensure or certification
				standards may not be charged separately as special services if the services
				were included as allowable costs used to establish the current established
				rate. Special services may include cable television, telephones, long-distance
				calls, nonroutine hair care such as permanents requested by a resident, and the
				additional cost of brand name supplies requested by a resident and not
				ordinarily stocked. A facility shall inform the resident or a person acting on
				behalf of the resident that a charge may be made and the amount of the charge
				at the time a request for the special services is made.
c. A facility may charge to hold a bed for a
				period in excess of the periods covered by subsections 3, 4, 5, and 6 of
				section 75-02-06-14 if:
(1) The resident, or a person acting on
				behalf of the resident, has requested the bed be held and the facility informs
				the person making the request, at the time of the request, of the amount of the
				charge;
(2) For a medical
				assistance resident, the payment comes from sources other than from the
				resident's monthly income; and
(3)
				All residents are charged the same amount.
d. A facility may charge for medicare part A
				and part B coinsurance and deductibles.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-23 - Violation of chapter subjects facility to action

Current through Supplement No. 393, July, 2024
A facility that charges a private-pay resident a rate in
				  violation of this chapter is subject to action for civil damages. The damages
				  awarded may include three times the payments that result from the violation,
				  together with costs and disbursements, including reasonable attorney's fees or
				  their equivalent.
General Authority: NDCC
					 50-24.1-04,
					 50-24.4-02
Law Implemented: NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-24 - Exclusions

Current through Supplement No. 393, July, 2024
1. A facility that exclusively provides
				residential services for nongeriatric individuals with physical disabilities or
				a unit within a facility which exclusively provides geropsychiatric services
				shall not be included in the calculation of the rate limitations.
2. The rate for a unit within a facility
				which exclusively provides geropsychiatric services must be established using
				the actual allowable historical costs adjusted by the indices under subsection
				5 of section
				75-02-06-16. Actual allowable
				historical costs must be determined using the applicable sections of the
				policies and procedures. An operating margin and incentive determined under
				subsection 3 of section
				75-02-06-16 must be included in
				the facility's cost rate.
3. The
				direct care rate for a unit within a facility that exclusively provides
				geropsychiatric services must be established using the allowable historical
				operating costs and adjustment factors under subsection 4 of section
				75-02-06-16.3. The margin cap for
				direct care must be included in the facility's direct care rate.
4. The direct care rate for a facility that
				exclusively provides residential services for nongeriatric individuals with
				physical disabilities must be established using the allowable historical
				operating costs and adjustment factors under subsection 4 of section
				75-02-06-16.3. The direct care
				rate must be limited to two times the limit rate under subdivision c of
				subsection 3 of section
				75-02-06-16.3. The margin cap for
				direct care must be included in the facility's direct care rate up to two times
				the limit rate.
5. The other direct
				care rate and indirect care rate for a facility that exclusively provides
				residential services for nongeriatric individuals with physical disabilities
				must be limited to one and one-half times the limit rate set under subdivision
				c of subsection 3 of section
				75-02-06-16.3. The margin cap for
				other direct and indirect care must be included in the facility's rate up to
				one and one-half times the limit rate.
6. A facility may establish a rate for
				respite care, hospice inpatient respite care, or hospice general inpatient care
				services.
General Authority:
NDCC 50-24.1-04,
					 50-24.4-02
Law Implemented:
NDCC 50-24.4;
					 42 USC
					 1396
					 a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-25 - Notification of rates

Current through Supplement No. 393, July, 2024
1. The department
				shall notify each facility of the desk audit rate on or before November
				twenty-fourth of the year preceding the rate year, except a facility that has
				requested and received a cost reporting deadline extension of fifteen days or
				less shall be notified on or before November thirtieth of the year preceding
				the rate year, and a facility that has requested and received a cost reporting
				deadline extension in excess of fifteen days shall be notified on or before
				December fifteenth of the year preceding the rate year.
2. The department shall notify each facility
				of the cost rate and the price rate for the 2022 and 2023 rate years.
3. The facility shall notify the department
				on or before November 29, 2021, if the facility accepts the cost rate as the
				established rate for the 2022 rate year.
4. The facility shall notify the department
				on or before November 28, 2022, if the facility accepts the cost rate as the
				established rate for the 2023 rate year. The facility does not have the option
				to choose the cost rate for the 2023 rate year if the facility's 2022 rate was
				the price rate.
5. The facility
				shall provide to all private-pay residents a thirty-day written notification of
				any increase in the rates for each classification. An increase in rates is not
				effective unless the facility has notified private-pay residents that the rate
				increase is effective by the first day of the second month following the date
				of notification by the department. If the facility does not notify private-pay
				residents by the first day of the first month following notification by the
				department, the established rate in effect at the time of notification by the
				department must remain in effect until the date the rate is payable by
				private-pay residents. No retroactive adjustment may be made to an established
				rate that remains in effect because the facility did not promptly notify
				private-pay residents unless the adjustment would result in a decrease of at
				least the rate adjustment percentage per day. A facility may make a rate change
				without giving a thirty-day written notice when the purpose of the rate change
				is to reflect a necessary change in the case-mix classification of a resident.
6. If the department fails to
				notify the facility of the desk rate, as provided in subsection 1, the time
				required for giving written notice, as provided for in subsection 5, must be
				decreased by the number of days by which the department was late in setting the
				rate.
General Authority:
NDCC 50-24.1-04,
					 50-24.4-02
Law Implemented:
NDCC 50-24.4;
					 42 USC
					 1396a(a)(13)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-26 - Reconsiderations

Current through Supplement No. 393, July, 2024
1. Any requests for reconsideration of the
				final rate must be filed with the department's medical services division within
				thirty days of the date of the rate notification.
2. A request for reconsideration must
				include:
a. A statement of each disputed item
				and the reason or basis for the dispute;
b. The dollar amount of each adjustment that
				is disputed; and
c. The authority
				in statute or rule upon which the facility is relying for each disputed
				item.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-01 - Definitions

Current through Supplement No. 393, July, 2024
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. "Actual rate"
				means the facility rate for each cost category calculated using allowable
				historical operating costs and adjustment factors.
3. "Adjustment factor" means the
				legislatively approved inflation rate for basic care services.
4. "Admission" means any time a resident is
				admitted to the facility from an outside location, including readmission
				resulting from a discharge.
5. "Aid
				to vulnerable aged, blind, and disabled individuals" means a program that
				supplements the income of an eligible beneficiary who resides in a
				facility.
6. "Allowable cost" means
				the facility's actual cost after appropriate adjustments as required by basic
				care regulations.
7. "Alzheimer's
				and related dementia facility" means a licensed basic care facility which
				primarily provides services specifically for individuals with Alzheimer's
				disease or related dementia.
8.
				"Bona fide sale" means the purchase of a facility's capital assets with cash or
				debt in an arm's-length transaction. It does not include:
a. A purchase of shares in a corporation that
				owns, operates, or controls a facility except as provided under subsection 4 of
				section 75-02-07.1-13;
b. A sale and leaseback to the same
				licensee;
c. A transfer of an
				interest to a trust;
d. Gifts or
				other transfer for nominal or no consideration;
e. A change in the legal form of doing
				business;
f. The addition or
				deletion of a partner, owner, or shareholder; or
g. A sale, merger, reorganization, or any
				other transfer of interest between related organizations.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-02 - Financial reporting requirements

Current through Supplement No. 393, July, 2024
1.
				Records.
a. The facility shall maintain on
				the premises the required census records and financial information in a manner
				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 report item.
b.
				Where several facilities are associated with a group and their accounting and
				reports are centrally prepared, added information must be submitted, for those
				items known to be lacking support at the reporting facility, with the cost
				report or must be provided to the local facility prior to the audit or review
				of the facility. Accounting or financial information regarding related
				organizations must be readily available to substantiate cost. Home office cost
				reporting and cost allocation must be in conformance with applicable sections
				in this chapter.
c. Each provider
				shall maintain, for a period of not less than five years following the date of
				submission of the cost report to the department, accurate financial and
				statistical records of the period covered by such cost report in sufficient
				detail to substantiate the cost data reported. Each provider shall make such
				records available upon reasonable demand to representatives of the
				department.
d. Except for motor
				vehicles used exclusively for resident-related activities, the provider shall
				maintain a mileage log for all motor vehicles that identifies mileage and
				purpose of each trip. Vehicle mileage for nonresident-related activities must
				be documented.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-03 - General cost principles

Current through Supplement No. 393, July, 2024
1. For
				ratesetting purposes, a cost must:
a. Be
				ordinary, necessary, and related to resident care;
b. Be what 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 goods or services actually provided
				in the facility.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-04 - Participation requirement

Current through Supplement No. 393, July, 2024
A facility may not receive aid to vulnerable aged, blind, and
				  disabled individuals assistance payments unless it complies with all provisions
				  of this section.
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 periods covered under subsection 2 or 3 of section
				75-02-07.1-05 if:
a. The resident, or a person acting on behalf
				of the resident, has requested the bed be held and the facility informs the
				person making the request, at the time of the request, of the amount of the
				charge; and
b. For an eligible
				beneficiary, the payment comes from sources other than from the beneficiary's
				monthly income.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-05 - Resident census

Current through Supplement No. 393, July, 2024
1. Adequate census
				records must be prepared and maintained on a daily basis by the facility to
				allow for proper audit of the census data. The daily census records must
				include:
a. Identification of the
				resident;
b. Entries for all days,
				and not just by exception;
c.
				Identification of type of day, i.e., medical care, in-house; and
d. Monthly totals by resident and by type of
				day.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-06 - Direct care costs

Current through Supplement No. 393, July, 2024
Direct care costs include only those costs identified in this
				  section.
1.
Resident
				care.
a. Salary and employment
				benefits for the director or supervisor of resident care staff, inservice
				trainers for resident care staff, quality assurance personnel, resident care
				aides, medication aides, and ward clerks.
b. Routine hair and personal hygiene items
				and services furnished routinely and relatively uniformly to all residents;
				items stocked at nursing stations or on the floor in gross supply and
				distributed or used individually in small quantities; and items used by
				individual residents that are reusable, vary by the needs of the individual,
				and are expected to be available in the facility.
c. Medically necessary items, services, and
				durable medical equipment which could otherwise be billed directly to medicaid
				if the facility chooses to provide them.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-07 - Indirect care costs

Current through Supplement No. 393, July, 2024
Indirect care costs include all costs specifically identified
				  in this section. Indirect care costs must be included in total, without direct
				  or indirect allocation to other cost categories unless specifically provided
				  for elsewhere.
1.
Administration.
Costs for administering the overall activities of
				the facility include:
a. Salary and employment
				benefits for administrators, except that part of an administrator's salary may
				be allocated to other cost categories provided adequate records identifying the
				hours and services provided are maintained by the facility.
b. Salary and employment benefits for
				assistant administrators, top management personnel, accounting personnel,
				clerical personnel, secretaries, receptionists, data processing personnel,
				purchasing, receiving and store personnel, medical director, and salary and
				employment benefits of all personnel not designated in other cost
				categories.
c. Board of directors'
				fees and related travel expenses.
d. Security personnel or services.
e. Supplies except as specifically provided
				for in the direct care and other cost centers of the indirect care cost
				category.
f. Insurance, except
				insurance included as a fringe benefit and insurance included as part of
				related party lease costs.
g.
				Telephone.
h. Postage and
				freight.
i. Membership dues and
				subscriptions.
j. Professional fees
				for services such as legal, accounting, and data processing.
k. Central or home office costs including
				property costs, but not including costs that may be allocated to other cost
				centers under subsection 4 of section
				75-02-07.1-12.
l. Advertising and personnel recruitment
				costs.
m. Management consultants
				and fees.
n. Business meetings,
				conventions, association meetings, and seminars.
o. Travel.
p. Training, including inservice
				training.
q. Business office
				functions.
r. Computer software
				costs, except costs that must be capitalized, and computer maintenance
				contracts.
s. Working capital
				interest.
t. Any costs that cannot
				be specifically classified to other cost categories.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-08 - Property costs

Current through Supplement No. 393, July, 2024
Property-related costs and pass-through costs include only
				  those costs identified in this section.
1. Depreciation.
2. Interest expense on capital debt.
3. Property taxes including
				special assessments as provided for in section
				75-02-07.1-17.
4. Lease and rental costs.
5. Startup costs.
6. Reasonable legal and related expenses:
a. Incurred or as a result of a successful
				challenge to a decision by a governmental agency, made on or after July 1,
				1995, regarding a rate year beginning on or after July 1, 1995;
b. Related to legal services furnished on or
				after July 1, 1995; and
c. In the
				case of a partially successful challenge, not in excess of an amount determined
				by developing a ratio of total amounts claimed successfully to total amounts
				claimed in the partially successful challenge and applying that ratio to the
				total legal and related expenses paid.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-08.1 - Food and plant costs

Current through Supplement No. 393, July, 2024
Food and plant costs include only those costs identified in
				  this section.
1. The cost of
				consumable food products and dietary supplements.
2. The cost of heating and cooling,
				electricity, water, sewer and garbage, and cable television.
3. Repairs and maintenance contracts and
				purchased services.
4. Supplies
				necessary for repairs and maintenance of the facility, including hardware,
				building materials and tools, other maintenance-related supplies, and
				noncapitalized equipment not included elsewhere.
5. Allowable bad debt expense in the report
				year in which it was determined to be uncollectible with no likelihood of
				future recovery. The allowable bad debt expense may not exceed three hundred
				sixty-five days per individual.
General Authority:
NDCC 50-06-16
Law Implemented:
NDCC
					 50-24.5-02(3)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-11 - Offsets to costs

Current through Supplement No. 393, July, 2024
1. Several items of
				income must be considered as offsets against various costs as recorded in the
				books of the facility. Income received by the facility in any form must be
				offset up to the total of the appropriate allowable costs, with the following
				exceptions:
a. The established rate;
b. Income from payments made under the Job
				Training Partnership Act;
c. Income
				from charges for private rooms or special services;
d. Noncovered bed hold days; or
e. The deferred portion of patronage
				dividends credited to the facility and not previously offset.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-07.1 - Ratesetting for Basic Care Facilities › Section 75-02-07.1-12 - Home office costs

Current through Supplement No. 393, July, 2024
1. Home
				offices of chain organizations vary greatly in size, number of locations,
				staff, mode of operations, and services furnished to member facilities.
				Although the home office of a chain is normally not a provider in itself, it
				may furnish central administration or other services including centralized
				accounting, purchasing, personnel, or management services. To the extent the
				home office furnishes services related to resident care to a facility, the
				reasonable resident-related costs, not to exceed actual costs of the services,
				are includable in the facility's cost report and are includable as part of the
				facility's rate.
2. Where the home
				office makes a loan to or borrows money from one of the components of a chain
				organization, the interest paid is not an allowable cost and interest income is
				not used to offset interest expense.
3. Home office costs incurred for expansion
				of a chain organization must be directly allocated to the appropriate component
				of the chain. The costs of abandoned plans are not allowable.
4. Central or home office costs representing
				services of consultants required by law in areas for social services, nursing,
				therapies, or activities and central, affiliated, or corporate office costs
				representing services of consultants not required by law in the areas of
				resident care may be allocated to the appropriate cost category of a facility
				according to subdivisions a through e.
a.
				Only the salaries and employment benefits associated with the individual
				performing the service may be allocated. No other costs may be allocated.
b. The allocation must be based on
				direct identification and only to the extent justified in time distribution
				records that show the actual time spent by the consultant performing the
				services in the facility.
c. The
				cost in subdivision a for each consultant may not be allocated to more than one
				cost category in the facility. If more than one facility is served by a
				consultant, all facilities shall allocate the consultant's cost to the same
				operating category.
d. Top
				management personnel may not be considered consultants.
e. An allocation may not be made unless the
				consultant's full-time responsibilities are to provide the services identified
				in this section.