North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-04 - Developmental Disabilities › Chapter 75-04-05 - Payment for Provider Agencies of Services to Individuals with Intellectual Disabilities - Developmental Disabilities › Section 75-04-05-01 - Definitions

Current through Supplement No. 393, July, 2024
In this chapter, unless the context or subject matter
				  requires otherwise:
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 costs in the period when incurred,
				regardless of when they are paid.
2. "Administrative costs" means those costs
				that are necessary to operate the business but are not client
				related.
3. "Allowable cost" means
				the program's actual and reasonable cost after appropriate adjustments for
				nonallowable costs, income, offsets, and limitations.
4. "Assessment score" means the client's
				score from the standard assessment tool administered by the department or its
				designee.
5. "Bad debts" means
				those amounts considered to be uncollectible from accounts and notes receivable
				which were created or acquired in providing covered services that are eligible
				for payment through Medicaid federal financial participation.
6. "Basic services" means all of the services
				that provider agencies deliver to clients, including nondevelopmental
				disabilities services.
7. "Board"
				means all food and dietary supply costs.
8. "Capital asset" means a facility's
				buildings, land improvements, fixed equipment, movable equipment, leasehold
				improvements, and all additions to or replacements of those assets used for
				client care.
9. "Client" means an
				individual found eligible as determined through the application of
				chapter
				75-04-06 for services
				coordinated through developmental disabilities program management on whose
				behalf services are provided or purchased.
10. "Client-authorized representative" means
				a person who has legal authority, either designated or granted, to make
				decisions on behalf of the client.
11. "Client representative" means a
				client-authorized representative or relative who has maintained significant
				contacts with the client.
12.
				"Community contribution" means a contribution to a civic organization or
				sponsorship of community activities. Community contribution does not include a
				donation to a charity.
13. "Cost
				center" means a division, department, or subdivision thereof, group of services
				or employees or both, or any unit or type of activity into which functions of a
				provider agency are divided for purposes of cost assignment and
				allocations.
14. "Day habilitation"
				means a day program of scheduled activities, formalized training, and staff
				supports to promote skill development for the acquisition, retention, or
				improvement in self-help, socialization, and adaptive skills. Activities must
				focus on improving a client's sensory motor, cognitive, communication, and
				social interaction skills.
15.
				"Department" means the North Dakota department of human services.
16. "Depreciation" means an allocation of the
				cost of an asset over its estimated useful life.
17. "Depreciable asset" means a capital asset
				or other asset for which the cost must be capitalized for statement of costs
				purposes.
18. "Depreciation
				guidelines" means the American hospital association's guidelines as published
				by American hospital publishing, inc., in the most recently published
				"Estimated Useful Lives of Depreciable Hospital Assets".
19. "Direct care staff" means employees who
				are actively providing support to clients receiving a service from a provider
				agency.
20. "Direct care wage"
				means the wage level that is used as the basis of the payment system.
21. "Direct program support costs" means
				costs that are specific to the service provision of a client, including medical
				and program supplies.
22.
				"Documentation" means the furnishing of written or electronic records,
				including original invoices, contracts, timecards, and workpapers prepared to
				complete reports or for filing with the department.
23. "Employment-related expenses" means
				employee benefits, including federal Insurance Contributions Act, unemployment
				insurance, medical insurance, workers' compensation, retirement, disability,
				long-term care insurance, dental, vision, life, accrued paid time off, and
				unrecovered medical costs furnished at the provider agency's cost.
24. "Employment support" means ongoing
				supports to assist clients in obtaining and maintaining paid employment in an
				integrated setting. Services are designed for clients who need intensive
				ongoing support to perform in a work setting. Service includes on-the-job or
				off-the-job employment-related support for clients needing intervention to
				assist them in maintaining employment, including job development. Employment
				support includes individual employment support and small group employment
				support.
25. "Facility-based" means
				a facility for individuals with developmental disabilities licensed by the
				department to provide day services. This definition is not to be construed to
				include areas of the building determined by the department to exist primarily
				for nontraining.
26. "Fair market
				value" means value at which an asset could be sold in the open market in an
				arm's-length transaction between unrelated parties.
27. "Fixed equipment" means equipment used
				for client care affixed to a building, not easily movable, and identified as
				such in the depreciation guidelines.
28. "Generally accepted accounting
				principles" means the accounting principles approved by the American institute
				of certified public accountants.
29. "Group home" means any community
				residential service facility, licensed by the department pursuant to North
				Dakota Century Code chapter 25-16, housing more than three individuals with
				developmental disabilities. "Group home" does not include a community complex
				with self-contained rental units.
30. "Historical cost" means those costs
				incurred and recorded on the facility's accounting records as a result of an
				arm's-length transaction between unrelated parties.
31. "Hospital leave day" means any day that a
				client is not in the facility, but is in an acute care setting as an inpatient
				and is expected to return to the facility. A hospital leave day is only
				available to clients residing in an intermediate care facility for individuals
				with intellectual disabilities.
32.
				"In-house day" means a day that a client was actually receiving services in the
				intermediate care facility for individuals with intellectual disabilities
				setting and was not on therapeutic leave, in the hospital, or absent.
33. "Indirect program support costs" means
				costs that are neither direct care nor administrative, such as program
				development, supervision and quality assurance, and are not separately
				billable.
34. "In-home supports"
				means supports for a client residing with their primary caregiver and their
				family to prevent or delay unwanted out-of-home placement. Services may assist
				the client in activities of daily living, and help with maintaining health and
				safety.
35. "Interest" means the
				cost incurred with the use of borrowed funds.
36. "Intermediate care facility for
				individuals with intellectual disabilities" means a residential health facility
				operated pursuant to title 42, Code of Federal Regulations, parts 442 and 483,
				et seq.
37. "Land improvements"
				means any improvement to the land surrounding the facility used for client care
				and identified as such in the depreciation guidelines.
38. "Life-changing event" means a change in a
				client's life that will affect his or her support needs for six months or more,
				including a significant medical event, a crisis situation, a change in living
				arrangement, aging caregiver, significant medical or behavioral health event in
				the life of a caregiver, significant change in family functioning, or
				trauma.
39. "Medical assistance
				program" means the program that pays the cost of medical care and other
				services to eligible clients pursuant to North Dakota Century Code chapter
				50-24.1.
40. "Movable equipment"
				means movable care and support services equipment generally used in a facility,
				including equipment identified as major movable equipment in the depreciation
				guidelines.
41. "Net investment in
				fixed assets" means the cost, less accumulated depreciation and the balance of
				notes and mortgages payable.
42.
				"Other asset" means any asset that has a life of more than one year and has a
				cost of five thousand dollars or greater.
43. "Parenting supports" means assisting
				clients who are or will be parents in parenting skills training that is
				individualized to assist with focusing on the health, welfare, and
				developmental needs of their child.
44. "Person-centered service plan" means an
				individual plan that identifies service needs of the eligible client, the
				services to be provided, and is developed by the client or client-authorized
				representative, or both, client select team, and developmental disabilities
				program manager considering all relevant input.
45. "Personal assistance retainer" means a
				payment used in residential habilitation to allow continued reimbursement
				during a client's temporary absence from the setting. The personal assistance
				retainer allows for payment while a client is hospitalized or otherwise away
				from the setting to ensure stability and continuity of staffing.
46. "Prevocational services" means formalized
				training, experiences, and staff supports designed to prepare clients for paid
				employment in integrated community settings. Services are structured to develop
				general abilities and skills that support employability in a work setting.
Services are not directed at teaching job-specific skills,
				  but at specific habilitative goals outlined in the client's person-centered
				  service plan.
47. "Program
				support" means the direct and indirect program support costs that support
				providing services to a client.
48.
				"Program support staff" means employees whose duties are associated with client
				care but who are not actively providing direct support services to clients
				receiving a service from a provider agency.
49. "Property costs" means the cost category
				for allowable costs to operate the owned or leased property.
50. "Provider agency" means the organization
				or individual who has executed a Medicaid agreement with the department to
				provide services to individuals with developmental disabilities.
51. "Reasonable cost" means the cost that
				must be incurred by an efficiently and economically operated facility to
				provide services in conformity with applicable state and federal laws,
				regulations, and quality and safety standards.
52. "Related organization" means an
				organization which a provider agency is, to a significant extent, associated
				with, affiliated with, able to control, or controlled by, and which furnishes
				services, facilities, or supplies to the provider agency. Control exists when
				an individual or an organization has the power, directly or indirectly,
				significantly to influence or direct the action or policies of an organization
				or institution.
53. "Relief staff"
				means the replacement of direct care staff when the regular direct care staff
				are on leave and there is a cost component in the direct care hourly rate that
				covers the cost of relief staff.
54. "Residential services" means formalized
				training and supports provided to clients to assist with and develop self-help,
				socialization, and adaptive skills that improve the client's ability to
				independently reside and participate in an integrated community. Residential
				services include residential habilitation and independent
				habilitation.
55. "Room" means the
				cost associated with the provision of shelter, housekeeping staff or purchased
				housekeeping services and the maintenance thereof, including depreciation and
				interest or lease payments of a vehicle used for transportation of
				clients.
56. "Service" means the
				provision of living arrangements and programs of daily activities subject to
				licensure by the department.
57.
				"Staff training" means an organized program to improve staff
				performance.
58. "Statement of
				costs" means the department-approved form for reporting costs, statistical
				data, and other relevant information of the provider agency.
59. "Statement of costs year" means the
				fiscal year from July first through June thirtieth.
60. "Therapeutic leave day" means any day
				that a client is not in the intermediate care facility for individuals with
				intellectual disabilities, nursing facility, swing-bed facility, transitional
				care unit, subacute unit, another intermediate care facility for individuals
				with intellectual disabilities, a basic care facility, or an acute care
				setting, or if not in an institutional setting, is not receiving home- and
				community-based waiver services and is expected to return to the facility. A
				therapeutic leave day is only available to clients residing in an intermediate
				care facility for the intellectually disabled.
61. "Top management personnel" means owners;
				board members; corporate officers; general, regional, and district managers;
				administrators; and any other person performing functions ordinarily performed
				by such personnel.
62. "Units of
				service" for billing purposes means:
a.
(1) In residential habilitation and
				intermediate care facility for individuals with intellectual disabilities, one
				client served for one twenty-four-hour day; or
(2) In day habilitation, prevocational
				services, employment supports, parenting supports, in-home supports, and
				independent habilitation settings, one client served for fifteen minutes .