reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-01 - Definitions

Current through Supplement No. 393, July, 2024
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 feeding, toileting, continence, transferring
				in and out of bed or chair or on and off the toilet, and mobility inside the
				home.
2. "Adaptive assessment"
				means an evaluation to identify adaptive devices, equipment, or modifications
				that enhance the independence and functional capabilities of an individual who
				may otherwise be unable to remain in the individual's home.
3. "Aged" means sixty-five years of age or
				older.
4. "Congenital disability"
				means a disability that exists at birth or shortly thereafter, and is not
				attributable to a diagnosis of either mental retardation or a closely related
				condition of mental retardation.
5.
				"Department" means the North Dakota department of health and human
				services.
6. "Designee" means a
				person that enrolls as a qualified service provider to provide case management
				services for the Medicaid waiver program.
7. "Disability due to trauma" means a
				disability that results from an injury or assault to the body by an external
				force.
8. "Disability that is
				acquired" means a disability that results from an assault that occurs
				internally within the body.
9.
				"Disabled" means under age sixty-five with a congenital disability, a
				disability due to trauma, or a disability that is acquired.
10. "Eligible individual" means an individual
				who meets the eligibility requirements and is receiving services reimbursed
				under North Dakota Century Code chapter 50-06.2 or this chapter.
11. "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 resources, health care
				coverage, and source and reason for referral; and to secure measurable
				information regarding:
a. Physical
				health;
b. Cognitive and emotional
				functioning;
c. Activities of daily
				living;
d. Instrumental activities
				of daily living;
e. Informal
				supports;
f. Need for
				twenty-four-hour supervision;
g.
				Social participation;
h. Physical
				environment;
i. Financial
				resources;
j. Adaptive
				equipment;
k. Environmental
				modification; and
l. Other
				information about the individual's condition not recorded elsewhere.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-02 - Eligibility criteria

Current through Supplement No. 393, July, 2024
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 applicant meets the special
				circumstances provided in subsection 4, 5, or 6 of section
				75-03-23-03.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-03 - Eligibility determination - Authorization of services

Current through Supplement No. 393, July, 2024
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 that the individual transferred
				to active status continues to meet the eligibility criteria for placement into
				the SPED program pool;
b.
				Developing a care plan;
c.
				Authorizing covered services in accordance with department policies and
				procedures;
d. Verifying the
				financial eligibility criteria in relation to income, assets, and deductions;
				and
e. Assuring that other
				potential federal and third-party funding sources for similar services are
				sought first.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-04 - Eligibility criteria for Medicaid waiver program

Current through Supplement No. 393, July, 2024
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:
a. The disability must not be
				the result of mental illness as the primary diagnosis or the result of mental
				retardation, or a closely related condition; and
b. The disability must meet the social
				security administration's definition of disability or the individual must be
				determined physically disabled by the state review team under section
				75-02-02.1-14.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-05 - Services covered under the SPED program - Programmatic criteria

Current through Supplement No. 393, July, 2024
Room and board costs may not be paid 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:
a. Who
				requires assistance in activities of daily living or instrumental activities of
				daily living;
b. Who is able to
				participate in group activities; and
c. Who, if the eligible individual does not
				live alone, has a primary caregiver who will benefit from the temporary relief
				of care giving.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-06 - Services covered under the Medicaid waiver program - Programmatic criteria

Current through Supplement No. 393, July, 2024
Room and board costs may not be included 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 individual:
a. Who
				requires assistance in activities of daily living or instrumental activities of
				daily living;
b. Who is able to
				participate in group activities; and
c. If the eligible individual does not live
				alone, the eligible individual's primary caregiver will benefit from the
				temporary relief of care giving.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-08.1 - Sanctions and termination of qualified service providers

Current through Supplement No. 393, July, 2024
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 agreement.
2. The department may consider the following
				in determining the sanction to be imposed:
a.
				Seriousness of the qualified service provider's offense.
b. Extent of the qualified service provider's
				violations.
c. Qualified service
				provider's history of prior violations.
d. Prior imposition of sanctions against the
				qualified service provider.
e.
				Prior provision of information and training to the qualified service
				provider.
f. Qualified service
				provider's agreement to make restitution to the department.
g. Actions taken or recommended by peer
				groups or licensing boards.
h.
				Access to care for eligible individuals.
i. Qualified service provider's
				self-disclosure or self-audit discoveries.
j. Qualified service provider's willingness
				to enter a business integrity agreement.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-09 - Payment under the SPED program and the Medicaid waiver program

Current through Supplement No. 393, July, 2024
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.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-10 - Department to recover funds upon establishment of noncompliance

Current through Supplement No. 393, July, 2024
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 to deliver the
				  services in accord with the provider agreement or department policy and
				  procedure.
General Authority: NDCC
					 50-06.2-03(6)
Law Implemented: NDCC
					 50-06.2-03(5),
					 50-06.2-03(6)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-11 - Denial, reduction, and termination of services - Appeal

Current through Supplement No. 393, July, 2024
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 right to appeal, and the appeal process as provided in
				chapter
				75-01-03.
2. An eligible individual must receive ten
				calendar days' written notice before termination of services occurs. The
				ten-day notice is not required if:
a. The
				eligible individual enters a basic care facility or a nursing
				facility;
b. The termination is due
				to changes in federal or state law;
c. The eligible individual requests
				termination of services; or
d. The
				eligible individual moves from the service area.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-12 - Provider - Request for review

Current through Supplement No. 393, July, 2024
A qualified service provider may request a review of denial
				  of payment in accordance with North Dakota Century Code section
				  50-24.1-24.
General Authority:
NDCC 50-06.2-03, 50-24.1-24
Law Implemented:
NDCC 50-06.2-03,
					 50-24.1-24
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-13 - Provider - Appeals

Current through Supplement No. 393, July, 2024
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 hearing may be
				  conducted in the manner provided in chapter 75-01 -03. A provider or applicant
				  who receives notice of termination or denial of the individual's qualified
				  service provider status and requests a timely review of that decision is not
				  eligible to provide services until a final decision has been made by the
				  department that reverses the decision to terminate or deny qualified service
				  provider status.
General Authority: NDCC
					 50-06.2-03
Law Implemented: NDCC
					 50-06.2-03
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-14 - Disqualifying transfers

Current through Supplement No. 393, July, 2024
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 making application for SPED services except as
				provided in subsection 2.
2. An
				individual is not ineligible for SPED benefits under this chapter by reason of
				subsection 1 to the extent that:
a. The value
				of the transferred assets when added to the value of the individual's other
				assets would not otherwise make the individual ineligible for SPED or does not
				decrease the individual's service fee.
b. The asset transferred was a home, and
				title to the home was transferred to:
(1) The
				individual's spouse; or
(2) The
				individual's son or daughter who is under the age of twenty-one or who is blind
				or disabled.
c. The
				assets:
(1) Were transferred to the
				individual's spouse or to another person for the sole benefit of the
				individual's spouse; or
(2) Were
				transferred from the individual's spouse to another person for the sole benefit
				of the individual's spouse.
d. The individual makes a satisfactory
				showing that:
(1) The individual intended to
				dispose of the assets at fair market value or for other valuable consideration,
				and the individual had an objectively reasonable belief that fair market value
				or its equivalent was received;
(2)
				The assets were transferred exclusively for a purpose other than to qualify for
				SPED benefits under this chapter; or
(3) All assets transferred for less than fair
				market value have been returned to the individual.
e. If a disqualifying transfer occurred five
				years prior to the date an individual initially applies for SPED services, the
				department will presume that the transfer was not for the purpose of obtaining
				SPED benefits.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-15 - Application - Applicant required to provide proof of eligibility

Current through Supplement No. 393, July, 2024
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 services on
				behalf of another individual. "An individual properly seeking services" means
				an individual of sufficient maturity and understanding to act responsibly on
				behalf of the individual for whom services are sought.
3. An application must include a functional
				assessment.
4. The individual
				seeking services under this chapter, or an individual properly seeking services
				on behalf of that individual, shall sign the application.
5. The department or its designee shall
				provide information concerning eligibility requirements, available services,
				and the rights and responsibilities of individuals seeking services under this
				chapter and of eligible individuals to all who require it.
6. The date of application is the date the
				department or its designee receives the properly signed application.
7. The individual seeking services under this
				chapter 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 other information required under this chapter.
General Authority:
NDCC 50-06.2-03
Law Implemented:
NDCC
					 50-06.2-03
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-16 - Reapplication after denial or termination

Current through Supplement No. 393, July, 2024
A provider or applicant whose qualified service provider
				  status has been terminated or denied may not reapply if:
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 application; except in the case of an
				individual who has been denied or terminated under subparagraph a of paragraph
				2 of subdivision b of subsection 2 of section 75-03-23-07, the individual may
				reapply after completion of the term of probation; or
2. The provider's or applicant's status as a
				qualified service provider has been denied or revoked three or more times and
				the most recent revocation or denial occurred within the three years
				immediately preceding the application date.
General Authority:
NDCC 50-06.2-03
Law Implemented:
NDCC 50-06.2-03
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-17 - Functional assessment

Current through Supplement No. 393, July, 2024
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. The functional assessment must include an
				interview with the individual in the home where the individual
				resides.
General Authority:
NDCC
					 50-06.2-03
Law Implemented:
NDCC
					 50-06.2-03
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-01 - Definitions

Current through Supplement No. 393, July, 2024
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 the social security administration in the supplemental
				security income program under title XVI of the Social Security Act
				[42 U.S.C.
				1381 et seq.].
3. "Department" means the department of
				health and human services.
4.
				"Disabled" has the same meaning as the term has when used by the social
				security administration in the supplemental security income program under title
				XVI of the Social Security Act [42 U.S.C. 1381 et seq.].
5. "Ex-SPED program pool" means the list
				maintained by the department which contains the names of eligible individuals
				for whom ex-SPED program funding is available when the eligible individuals'
				names are transferred from the ex-SPED program pool to ex-SPED program active
				status.
6. "Institution" means an
				establishment that makes available some treatment or services beyond food or
				shelter to four or more individuals who are not related to the
				proprietor.
7. "Instrumental
				activities of daily living" means activities to support independent living,
				including housekeeping, shopping, laundry, transportation, and meal
				preparation.
General Authority:
NDCC 50-24.7-02
Law Implemented:
NDCC
					 50-24.7
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-02 - Eligibility criteria

Current through Supplement No. 393, July, 2024
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;
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-03 - Eligibility determination - Authorization of services

Current through Supplement No. 393, July, 2024
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 policies and
				procedures; and
d. Assuring that
				other potential federal and third-party funding sources for similar services
				are sought first.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-04 - Application

Current through Supplement No. 393, July, 2024
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 of another individual, to the
				department. A proper individual means any individual of sufficient maturity and
				understanding to act responsibly on behalf of the applicant.
3. An application consists of an application
				for services, which includes a functional assessment.
4. Application forms must be signed by the
				applicant, an authorized representative, or, if the applicant is incompetent or
				incapacitated, someone acting responsibly for the applicant.
5. Information concerning eligibility
				requirements, available services, and the rights and responsibilities of
				applicants and eligible individuals must be furnished to all who require
				it.
6. The date of application is
				the date an application, signed by an appropriate individual, is received by
				the department.
General Authority:
NDCC 50-24.7-02
Law Implemented:
NDCC
					 50-24.7
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-05 - Applicant's or guardian's duty to establish eligibility

Current through Supplement No. 393, July, 2024
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
				  information as may be required by this chapter.
General Authority: NDCC
					 50-24.7-02
Law Implemented: NDCC
					 50-24.7
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-06 - Functional assessment

Current through Supplement No. 393, July, 2024
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 resources, health care coverage, and source and reason for
				referral; and to secure measurable information regarding:
a. Physical health;
b. Cognitive and emotional functioning;
c. Activities of daily living;
d. Instrumental activities of
				daily living;
e. Informal
				supports;
f. Need for
				twenty-four-hour supervision;
g.
				Social participation;
h. Physical
				environment;
i. Financial
				resources;
j. Adaptive equipment
				or environmental modification, or both; and
k. Other information about the individual's
				condition not recorded elsewhere.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-07 - Services covered under the ex-SPED program - Programmatic criteria

Current through Supplement No. 393, July, 2024
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
				requires assistance in activities of daily living or instrumental activities of
				daily living;
b. Who is able to
				participate in group activities; and
c. Who, if the eligible individual does not
				live alone, has a primary caregiver who will benefit from the temporary relief
				of caregiving.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-08 - Residency

Current through Supplement No. 393, July, 2024
For purposes of this chapter:
1. An individual is a resident of this state
				if the individual is not living in an out-of-state institution and is living in
				this state:
a. With intent to remain in this
				state permanently or for an indefinite period; or
b. Without intent if the individual is
				incapable of stating intent.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-09 - Denial, reduction, and termination of services - Appeal

Current through Supplement No. 393, July, 2024
1. The department 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 right to
				appeal, and the appeal process as provided in
				chapter
				75-01-03.
2. An eligible individual must receive ten
				calendar days' written notice before termination of services occurs. The
				ten-day notice is not required if:
a. The
				eligible individual enters a basic care facility or a nursing
				facility;
b. The termination is due
				to changes in federal or state law;
c. The eligible individual requests
				termination of services;
d. The
				eligible individual moves from the service area; or
e. The eligible individual is
				deceased.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-10 - Payment under the ex-SPED program

Current through Supplement No. 393, July, 2024
1.
				Payment for ex-SPED services may only be made to an enrolled qualified service
				provider who meets the standards described in
				chapter
				75-03-23.
2. The department shall establish provider
				rates for home and community-based services 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.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-11 - Department to recover funds upon establishment of noncompliance

Current through Supplement No. 393, July, 2024
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 to deliver
				  services in accord with the provider agreement or department policy and
				  procedure.
General Authority: NDCC
					 50-24.7-02
Law Implemented: NDCC
					 50-24.7
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-24 - Expanded Service Payments for Elderly and Disabled › Section 75-03-24-12 - Administration

Current through Supplement No. 393, July, 2024
The department must be responsible for the administration of
				  the program with respect to that applicant or eligible individual.
General Authority:
NDCC 50-24.7-02
Law Implemented:
NDCC
					 50-24.7
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-02

Current through Supplement No. 393, July, 2024
General Authority: NDCC
					 50-10.1-02,
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented: NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-03 - Duties of the state long-term care ombudsman

Current through Supplement No. 393, July, 2024
The state long-term care ombudsman shall:
1. Identify, investigate, and resolve
				complaints made by, or on behalf of, long-term care residents;
2. Investigate and resolve complaints
				involving long-term care service providers, representatives of providers,
				public agencies, or health and social service agencies or complaints that
				pertain to administrative action, inaction, or decisions that may adversely
				affect the health, safety, welfare, or rights of a long-term care resident,
				including the appointment and functions of guardians and representative
				payees;
3. Provide assistance to a
				long-term care resident in protecting the resident's health, safety, welfare,
				or rights;
4. Provide a long-term
				care resident with information and procedures to protect the long-term care
				resident's rights and to obtain health, safety, welfare, or rights services
				from long-term care service providers, public agencies, or health and social
				service agencies;
5. Develop and
				monitor the effectiveness of complaint registration and complaint resolution
				mechanisms that provide a long-term care resident regular and timely access to
				ombudsman services;
6. Represent
				the interests of a long-term care resident before governmental
				agencies;
7. Seek administrative
				and legal remedies to protect the health, safety, welfare, or rights of a
				long-term care resident;
8.
				Research, evaluate, comment on, and monitor the development and implementation
				of federal, state, and local laws, administrative rules, regulations, and other
				federal, state, and local policies and actions, pertaining to the health,
				safety, welfare, and rights of a long-term care resident;
9. Recommend changes and facilitate public
				comments on laws, rules, regulations, policies, actions, and decisions
				pertaining to the health, safety, welfare, and rights of a long-term care
				resident;
10. Provide training for
				the local and volunteer ombudsman and encourage the development of citizen
				organizations to take part in the ombudsman program;
11. Provide technical assistance for the
				development of a long-term care resident councils and family councils for the
				protection of each long-term care resident's well-being and rights;
				and
12. Perform other operations
				and projects required by federal and state aging services.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-04

Current through Supplement No. 393, July, 2024
General Authority: NDCC
					 50-10.1-02,
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented: NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-05 - Duties of the local ombudsman

Current through Supplement No. 393, July, 2024
The local ombudsman shall:
1. Investigate and resolve complaints
				involving long-term care service providers, or representatives of providers,
				public agencies, or health and social service agencies and pertaining to
				administrative action, inaction, or decisions that may adversely affect the
				health, safety, welfare, or rights of a long-term care resident;
2. Ensure that a long-term care resident in
				the local ombudsman's service area has regular, reliable, and timely access to
				the local and volunteer ombudsman;
3. Ensure that complaints and requests for
				assistance receive timely responses;
4. Represent the interests of a long-term
				care resident before governmental agencies and pursue administrative and legal
				remedies, to protect the health, safety, welfare, and rights of a long-term
				care resident;
5. Review and make
				necessary comments on existing and proposed statutes, rules, regulations, and
				other governmental policies and administrative actions pertaining to the
				health, safety, welfare, and rights of a long-term care resident;
6. Facilitate the opportunity for the public
				to comment on federal and state statutes, rules, regulations, policies, and
				administrative actions pertaining to the health, safety, welfare, and rights of
				a long-term care resident.
7.
				Advocate for and support the development of long-term care resident councils
				and long-term care family councils;
8. Recruit and train the volunteer ombudsman,
				maintain documentation , and investigate any complaints about the volunteer
				ombudsman, in the form and manner required by the department;
9. Conduct an annual evaluation of each
				volunteer ombudsman in the form and manner required by the department;
				and
10. Perform other operations
				and projects required by the state long-term care ombudsman.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-06 - Certification of the volunteer ombudsman -Qualifications

Current through Supplement No. 393, July, 2024
The state long-term care ombudsman may certify a volunteer
				  ombudsman. A volunteer ombudsman must be at least eighteen years of age. The
				  volunteer ombudsman is not paid and is not an employee of the department. Each
				  certified volunteer ombudsman must:
1.
				Have references and experiences that demonstrate the capability to fulfill
				comparable duties as those listed in section
				75-03-25-07;
2. Be free of conflicts of
				interest;
3. Possess any other
				qualifications that the state long-term care ombudsman determines necessary to
				fulfill the duties of the position;
4. Have completed initial and ongoing
				training;
5. Have agreed to abide
				by the confidentiality statement, the conflict of interest statement, and the
				position description;
6. Be able to
				communicate with long-term care residents and facility staff;
7. Be able to communicate with residents who
				may be physically or mentally impaired; and
8. Understand and have the ability to
				advocate on behalf of residents.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-07 - Duties of the volunteer ombudsman

Current through Supplement No. 393, July, 2024
The volunteer ombudsman shall:
1. Provide ombudsman services to protect the
				health, safety, welfare, and rights of a long-term care resident;
2. Be present at the ombudsman's assigned
				facility on a regular basis;
3.
				Maintain confidentiality in all ombudsman activities;
4. Receive and report concerns, issues, and
				complaints to the local ombudsman; and
5. Assist the local ombudsman with
				assessment, complaint resolution, and follow-up activities.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-08 - Restrictions on services offered by volunteer ombudsman

Current through Supplement No. 393, July, 2024
While in the role of the volunteer ombudsman in an assigned
				  long-term care facility, the local ombudsman may not:
1. Provide direct personal care to a
				long-term care resident;
2. Provide
				transportation for a long-term care resident; or
3. Conduct personal business for a long-term
				care resident.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-09 - Reasonable access to long-term care facility, residents, and records

Current through Supplement No. 393, July, 2024
The division of aging services of the department shall
				  ensure that the state, local, and volunteer ombudsmen have reasonable access
				  to:
1. A long-term care facility and a
				long-term care resident;
2. Review
				a long-term care resident's social and medical records, as provided under
				subsection 2 of North Dakota Century Code section
				50-10.1-04;
3. Review a long-term care resident's medical
				record if a court orders disclosure;
4. Open administrative records, policies, and
				documents of a long-term care facility; and
5. State licensure and certification records
				regarding long-term care facilities.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-10 - Conflict of interest

Current through Supplement No. 393, July, 2024
1. An ombudsman may not serve as guardian or
				conservator or in any other decisionmaking capacity for a long-term care
				resident who is in a facility served by the ombudsman.
2. An ombudsman or any member of the
				ombudsman's immediate family may not be a board member, have an ownership,
				operational, or investment interest in an existing or proposed long-term care
				facility, or be employed by, or participate in the management of, a long-term
				care facility .
3. An ombudsman may
				not have direct involvement in the licensure or certification of any long-term
				care facility.
4. An ombudsman may
				not receive or have the right to receive, directly or indirectly, any
				remuneration, in cash or in kind, under a compensation arrangement with an
				owner or operator of a long-term care facility.
5. An ombudsman may not accept gifts or
				gratuities of significant value from a long-term care facility or its
				management, a resident of or a legal representative of a resident of a
				long-term care facility to which the ombudsman is assigned.
6. The state long-term care ombudsman and any
				local ombudsman may not accept any money or other consideration from anyone
				other than the department for the performance of an act in the regular course
				the ombudsman's duties; a volunteer ombudsman, as an unpaid position, may not
				accept money or other consideration from anyone for the performance of an act
				in the regular course of the volunteer's work as an ombudsman.
7. An ombudsman should not serve residents of
				a facility in which an immediate family member resides.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-11 - Dismissal of an ombudsman

Current through Supplement No. 393, July, 2024
Any ombudsman may be dismissed if the ombudsman:
1. Fails to perform ombudsman services in a
				manner consistent with the program's policies and procedures;
2. Fails to maintain
				confidentiality;
3. Fails to report
				abuse, neglect, or exploitation of a long-term care resident if a report is
				requested by the resident or legal representative, or is required by law;
				or
4. Communicates a known false
				statement.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-12 - Legal counsel

Current through Supplement No. 393, July, 2024
Legal counsel shall be provided to any ombudsman against whom
				  suit or other legal action is brought or threatened to be brought in connection
				  with the performance of official ombudsman duties.
General Authority: NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented: NDCC
					 50-10.1-03(8)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-13 - Retaliation prohibited

Current through Supplement No. 393, July, 2024
A long-term care facility, and its agents, may not take or
				  threaten retaliatory action against a long-term care resident, an employee, or
				  any other individual because of the filing of a complaint by or on behalf of
				  the long-term care resident, or because of the provision of information to a
				  long-term care ombudsman constituting or relating to a complaint. Examples of
				  retaliatory actions include:
1. The
				discharge from or termination of employment;
2. The demotion, negative work performance
				evaluation, reduction of hours worked, reduction of benefits or work
				privileges, or reduction in remuneration for services of the employee; or
3. The restriction or prohibition
				of access by the employee to any place of employment or to individuals
				affiliated with the place of employment.
General Authority: NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented: NDCC
					 50-10.1-03(8),
					 50-10.1-05
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-14 - Resident's right to notice

Current through Supplement No. 393, July, 2024
The long-term care facility shall post, in a conspicuous
				  place in each long-term care facility, information about the ombudsman program,
				  how to file a complaint concerning administrative actions which affect any
				  long-term care resident, and the address where a complaint may be filed. The
				  long-term care facility shall provide copies of the posted information to each
				  long-term care resident, the long-term care resident's spouse, and any legal
				  representative of a long-term care resident at the time the long-term care
				  resident is admitted to the long-term care facility.
General Authority:
NDCC
					 50-10.1-03(8);
					 42 U.S.C.
					 3011, et seq.
Law Implemented:
NDCC
					 50-10.1-03(8),
					 50-10.1-05
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-25 - Ombudsman Program › Section 75-03-25-15 - Statewide uniform reporting system

Current through Supplement No. 393, July, 2024
1.
				The department shall establish a statewide uniform reporting system to collect
				and analyze information on complaints and conditions in long-term care
				facilities.
2. The department
				shall conduct the following actions through the statewide uniform reporting
				system:
a. Maintain and publicize the
				availability of a statewide toll-free telephone number for the reporting of
				complaints regarding long-term care issues;
b. Coordinate the receipt, investigation,
				referral, and resolution of complaints;
c. Maintain statistical information;
d. Compile and mail a statistical
				report to other agencies as required;
e. Gather and disseminate information
				regarding issues facing long-term care facilities;
f. Assist in the development of
				administrative and legislative proposals for improving the quality of life and
				care of a long-term care resident of a long-term care facility; and
g. File an annual report that includes a
				summary of cases, information and referral requests, and long-term care issues.