reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-04.1 - Child Support Guidelines › Section 75-02-04.1-11 - Parental responsibility for children in foster care or guardianship care

Current through Supplement No. 393, July, 2024
It is important that parents maintain a tie to and
				  responsibility for their child when that child is in foster care. Financial
				  responsibility for the support of that child is one component of the
				  maintenance of the relationship of parent and child. Parents of a child subject
				  to a guardianship order under North Dakota Century Code chapter 27-20.1 or
				  30.1-27 remain financially responsible for the support of that child.
1. In order to determine monthly net income,
				it is first necessary to identify the parent or parents who have financial
				responsibility for any child entering foster care or guardianship care, and to
				determine the net income of those financially responsible parents. If the
				parents of a child in foster care or guardianship care reside together, and
				neither parent has a duty to support any child who is not also a child of the
				other parent, the income of the parents, including imputed income of each
				parent, if applicable, must be combined and treated as the income of the
				obligor. In all other cases, each parent is treated as an obligor, and each
				parent's support obligation must be separately determined.
2. Unless subsection 3 applies to the
				obligor, the net income and the total number of children are applied to section
				75-02-04.1-10 to determine the
				child support amount. That child support amount is then divided by the total
				number of children to determine the child support obligation for each child in
				foster care or guardianship care. For purposes of this subsection, the "total
				number of children" means:
a. If a child
				entering foster care or guardianship care resides in the obligor's home, the
				total number of children residing in the obligor's home to whom the obligor
				owes a duty of support, including the child or children entering foster care or
				guardianship care, plus any other full siblings of the child or children
				entering foster care or guardianship care to whom the obligor owes a duty of
				support who are not residing in the obligor's home; or
b. If no child entering foster care or
				guardianship care resides in the obligor's home, the child or children entering
				foster care or guardianship care plus the full siblings of the child or
				children entering foster care or guardianship care to whom the obligor owes a
				duty of support.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-04.1 - Child Support Guidelines › Section 75-02-04.1-12 - Uncontested proceedings

Current through Supplement No. 393, July, 2024
In a proceeding where the obligor appears, but does not
				  resist the child support amount sought by the obligee, and in proceedings where
				  the parties agree or stipulate to a child support amount, credible evidence
				  describing the obligor's income and financial circumstances, which demonstrates
				  that the uncontested or agreed amount of child support conforms to the
				  requirements of this chapter, must be presented.
General Authority: NDCC
					 50-06-16,
					 50-09-25
Law Implemented: NDCC
					 14-09-09.7,
					 50-09-02(12);
					 42 USC
					 667
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-04.1 - Child Support Guidelines › Section 75-02-04.1-13 - Application

Current through Supplement No. 393, July, 2024
The child support guideline schedule amount is rebuttably
				  presumed to be the correct amount of child support in all child support
				  determinations, including both temporary and permanent determinations, and
				  including determinations necessitated by actions for the support of children of
				  married persons, actions seeking domestic violence protection orders, actions
				  arising out of divorce, actions arising out of paternity determinations,
				  actions based upon a claim for necessaries, actions arising out of juvenile
				  court proceedings, interstate actions for the support of children in which a
				  court of this state has the authority to establish or modify a support order,
				  and actions to modify orders for the support of children. The fact that two or
				  more such actions may be consolidated for trial or otherwise joined for
				  convenient consideration of facts does not prevent the application of this
				  chapter to those actions.
General Authority: NDCC
					 50-06-16,
					 50-09-25
Law Implemented: NDCC
					 14-09-09.7,
					 50-09-02(12);
					 42 USC
					 667
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-04.2 - State Disbursement Unit › Section 75-02-04.2-01 - 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 14-09 or 50-09 unless the context indicates
				  otherwise. In addition:
1. "Child support case" means the combination of a
				  noncustodial parent or putative father, custodial parent, and children in
				  common.
2. "IV-D case" means a child support case that is serviced by
				  the child support agency under title IV-D.
3. "Non-IV-D case" means a child support case that is not
				  serviced by the child support agency under title IV-D.
General Authority: NDCC
					 50-09-02
Law Implemented: NDCC
					 50-09-02
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-04.2 - State Disbursement Unit › Section 75-02-04.2-02 - Fees for child support enforcement services

Current through Supplement No. 393, July, 2024
1. For purposes of this section, "year" means
				federal fiscal year.
2. Unless
				subsection 3 applies, an individual who is an obligee in a IV-D case and who
				has never received assistance under the aid to families with dependent children
				program or temporary assistance for needy families program and for whom the
				child support agency has collected and disbursed at least five hundred dollars
				in child support in any given year will be assessed an annual fee of
				twenty-five dollars. The child support agency will retain the fee from child
				support collected on behalf of the obligee.
3. An obligee in a IV-D case is exempt from
				the fee assessed under subsection 2 if:
a.
				The child support agency is providing services as a responding jurisdiction in
				an interjurisdictional case; or
b.
				The obligee is a medicaid recipient who has opted out of child support
				enforcement services.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-01 - Purpose

Current through Supplement No. 393, July, 2024
The purpose underlying administrative remedies and sanctions
				  in the Medicaid and children's health insurance program is to ensure the proper
				  and efficient utilization of Medicaid and children's health insurance program
				  funds by those individuals providing medical and other health services and
				  goods to recipients.
General Authority:
NDCC 50-06-01.9,
					 50-24.1-04, 50-29-02
Law Implemented:
NDCC
					 50-24.1-01
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-02 - Authority and objective

Current through Supplement No. 393, July, 2024
Under authority of North Dakota Century Code chapters 50-24.1
				  and 50-29, the department of human services is empowered to promulgate such
				  rules and regulations necessary to qualify for federal funds under section 1901
				  specifically, title XIX and title XXI generally of the Social Security Act.
				  These rules are subject to the Medicaid and children's health insurance program
				  state plan and to applicable federal law, federal regulation , state law, and
				  state rules.
General Authority:
NDCC 50-06-01.9,
					 50-06-05.1, 50-24.1-04, 50-29-02
Law Implemented:
NDCC
					 50-24.1-04
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-03 - Definitions

Current through Supplement No. 393, July, 2024
In this chapter, unless the context or subject matter
				  otherwise requires:
1. "Abuse" means
				practices that:
a. Are inconsistent with
				sound fiscal, business, or medical practices and result in an unnecessary cost
				to Medicaid and children's health insurance program;
b. Elicit reimbursement for services that are
				not medically necessary;
c. Are in
				violation of an agreement or certificate of coverage; or
d. Fail to meet professionally recognized
				standards for health care.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-04.1 - Denial of application to become a Medicaid or children's health insurance program provider

Current through Supplement No. 393, July, 2024
The department may deny an application to become a Medicaid
				  or children's health insurance program provider if:
1. The applicant voluntarily withdraws the
				application;
2. The applicant is
				not in compliance with applicable federal law, federal regulation, state law,
				state rules, or program issuances governing providers;
3. The applicant, if previously enrolled as a
				Medicaid or children's health insurance program provider, was not in compliance
				with the terms set forth in the application or provider agreement;
4. The applicant, if previously enrolled as a
				Medicaid or children's health insurance program provider, was not in compliance
				with the provider certification terms on the claims submitted for
				payment;
5. The applicant, if
				previously enrolled as a Medicaid or children's health insurance program
				provider, had demonstrated a pattern of submitting inaccurate billings or cost
				reports;
6. The applicant, if
				previously enrolled as a Medicaid or children's health insurance program
				provider, had demonstrated a pattern of submitting billings for services not
				covered under department programs;
7. The applicant has been debarred or the
				applicant's license or certificate to practice in the applicant's profession or
				to conduct business has been suspended or terminated;
8. The applicant delivers goods, supplies, or
				services that are of an inferior quality or are harmful to
				individuals;
9. The applicant has
				been convicted of an offense in section 75-02-05-11, which is determined by the
				department to have a direct bearing upon the applicant's ability to be enrolled
				as a Medicaid or children's health insurance program provider, or the
				department determines, following conviction of any other offense, the applicant
				is not sufficiently rehabilitated;
10. The applicant, if previously enrolled as
				a Medicaid or children's health insurance program provider, owes the department
				money for payments incorrectly made to the provider;
11. The provider is currently excluded from
				participation in Medicare, Medicaid, children's health insurance program, or
				any other federal health care program; and
12. For good cause.
General Authority:
NDCC 50-06-01.9,
					 50-24.1-04, 50-29-02
Law Implemented:
42 CFR
					 431.107
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-04.2 - Termination of provider enrollment

Current through Supplement No. 393, July, 2024
The department may terminate the enrollment of a Medicaid or
				  children's health insurance program provider under the following
				  circumstances:
1. The individual is
				enrolled to provide transportation, but does not possess a current driver's
				license or has a driver's license that has been suspended or revoked;
2. The enrolled provider fails to revalidate
				its enrollment per federal requirements and according to the re-enrollment
				schedule established by the department;
3. The enrolled provider or practitioner does
				not submit a Medicaid or children's health insurance program claim to the
				department for twenty-four months or more;
4. There is a loss of contact with the
				enrolled provider; or
5. As a
				result of sanction imposed in accordance with section 75-02-05-07 or North
				Dakota Century Code chapter 50-24.8.
General Authority:
NDCC 50-06-01.9,
					 50-24.1-04, 50-24.1-36, 50-29-02
Law Implemented:
NDCC 50-24.1-36; 42 CFR
					 431.107
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-06 - Reporting of violations and investigation

Current through Supplement No. 393, July, 2024
1. Information from
				any source indicating that a provider has failed or is failing to fulfill the
				provider's responsibilities, as set forth in section
				75-02-05-04;
				or that a provider has acted in a manner which forms a ground for sanction as
				set forth in section
				75-02-05-05
				must be transmitted to the department.
2. The department shall investigate the
				matter and, if the report is substantiated, shall take whatever action or
				impose whatever sanction is most appropriate. The taking of any action or the
				imposition of any sanction does not preclude subsequent or simultaneous civil
				or criminal court action.
3.
a. The department may investigate suspected
				fraud or abuse. The department may conduct an investigation to determine
				whether:
(1) Fraud or abuse exists and can be
				substantiated;
(2) Sufficient
				evident exists to support the recovery of overpayments or the imposition of
				sanctions; or
(3) The matter should
				be referred for action by another agency, including a law enforcement agency,
				to determine whether sufficient evidence exists to pursue any other civil or
				criminal action permitted by law.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-07 - Activities leading to and including sanction

Current through Supplement No. 393, July, 2024
1.
a. When
				the department determines that a provider has been rendering care or services
				in a form or manner inconsistent with program requirements or rules, or has
				received payment for which the provider may not be properly entitled, the
				department shall notify the provider in writing of the discrepancy noted. The
				notice to the provider may set forth:
(1) The
				nature of the discrepancy or inconsistency.
(2) The dollar value, if any, of such
				discrepancy or inconsistency.
(3)
				The method of computing such dollar values.
(4) Further actions which the department may
				take.
(5) Any action which may be
				required of the provider.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-09 - Review and appeal

Current through Supplement No. 393, July, 2024
1. A provider may
				not request a review of a temporary sanction until further investigation has
				been completed and the department has made a final decision.
2. After completion of further investigation,
				if there is an imposition of a subsequent sanction, the provider may request a
				review of the sanction pursuant to subsection 6 of North Dakota Century Code
				section 50-24.1-36.
3. A provider
				who is aggrieved by the decision the department issues in response to a request
				for review may appeal as set forth in subsection 6 of North Dakota Century Code
				section 50-24.1-36.
4. An applicant
				may appeal a decision to deny enrollment or terminate provider enrollment by
				filing a written appeal with the department within fifteen days of the date of
				the written notice of the denial or termination. Upon receipt of a timely
				appeal, an administrative hearing may be conducted in the manner provided in
				chapter 75-01-03. An applicant who receives notice of denial 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
				deny the application.
General Authority:
NDCC 50-06-01.9, 50-09-02,
					 50-24.1-04
Law Implemented:
NDCC 23-01-03, 23-16-01,
					 23-17.1-01, 23-20.1-04, 23-27-01, 25-16-02, 26.1-18-02, 43-05-09, 43-06-08,
					 43-12.1-03, 43-13-15, 43-15-15, 43-17-34, 43-26-13, 43-28-10, 43-32-17,
					 43-33-02, 43-37-03, 50-11.1-03, 50-24.1-36; NDAC 75-01-03;
					 42 USC
					 1396a(a)(39); 42 CFR
					 431.151; 42 CFR 455.13
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05 - Provider Integrity › Section 75-02-05-12 - Application fee

Current through Supplement No. 393, July, 2024
The department shall assess an application fee for all
				  institutional providers who have not been assessed an application fee by
				  centers for Medicare and Medicaid services or another state Medicaid agency.
				  The amount of the application fee is determined by centers for Medicare and
				  Medicaid services and is specific to a calendar year.
General Authority:
NDCC 50-06-01.9,
					 50-24.1-04, 50-29-02
Law Implemented:
NDCC
					 50-24.1-01
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-02 - Available enforcement remedies

Current through Supplement No. 393, July, 2024
The following enforcement remedies may be imposed on a
				  facility that is not in substantial compliance.
1.
Category one remedies:
a. A directed plan of care.
b. Directed in-service training.
c. State monitoring.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-03 - Enforcement action

Current through Supplement No. 393, July, 2024
The department may impose the enforcement remedies described
				  in section
				  75-02-05.2-02 if the facility is
				  not in substantial compliance. The scope and severity matrix established by the
				  health care financing administration must be used to determine the appropriate
				  category of enforcement remedy or remedies to be imposed.
1. If immediate jeopardy to the health or
				safety of residents exists, the department shall impose a remedy provided in
				subdivision a or b and may, in addition, impose any or all remedies provided in
				subdivisions c, d, and e. The department may:
a. Terminate the provider agreement no later
				than twenty-three days after the immediate jeopardy is identified if the
				immediate jeopardy is not removed by the twenty-first day;
b. Appoint a receiver to oversee the
				operation of the facility to ensure the health and safety of residents, where
				there is a need for a temporary management while:
(1) There is an orderly closure of the
				facility; or
(2) Improvements are
				made in order to bring the facility into substantial compliance;
c. Impose a civil money penalty of
				at least three thousand fifty dollars per day and not exceeding ten thousand
				dollars per day, effective as of the date the noncompliance was identified;
d. Immediately impose state
				monitoring; or
e. Impose any other
				remedy identified in section
				75-02-05.2-02, beginning at least
				two days from the date the provider receives notice of the remedy to be
				imposed.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-04 - Civil money penalties

Current through Supplement No. 393, July, 2024
1. The
				department may impose a civil money penalty for the number of days a provider
				is not in substantial compliance with one or more participation requirements.
2. The department may impose a
				civil money penalty for the number of days of past noncompliance since the last
				standard survey.
3. A minimum of
				fifty dollars per day and a maximum of three thousand dollars per day in
				penalties may be imposed when immediate jeopardy
does not exist, but deficiencies either caused actual harm or
				  caused no acutal harm, but have the potential for more than minimal harm.
4. A minimum of three
				thousand fifty dollars per day and a maximum of ten thousand dollars per day in
				penalties may be imposed when immediate jeopardy exists or when immediate
				jeopardy does not exist if a penalty in the lower range of penalty identified
				in subsection 3 was previously imposed and deficiencies are repeated.
5. A civil money penalty imposed
				under subsection 4 must be decreased to the range of penalties provided in
				subsection 3 when the penalty was imposed for a situation of immediate jeopardy
				and the immediate jeopardy is removed, but noncompliance continues.
6. The following factors must be considered
				in determining the amount of a civil money penalty to impose.
a. The seriousness of the deficiency
				determined by:
(1) Severity measured as:
(a) No actual harm with a potential for
				minimal harm;
(b) No actual harm
				with a potential for more than minimal harm, but not immediate jeopardy;
(c) Actual harm that is not
				immediate jeopardy; or
(d)
				Immediate jeopardy to residents' health or safety; and
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-05 - Imposition of enforcement remedies

Current through Supplement No. 393, July, 2024
1. The
				survey agency shall recommend enforcement action.
2. The department shall consider the survey
				agency recommendation when determining the appropriate enforcement action,
				except the appointment of a receiver must be as provided in North Dakota
				Century Code chapter 23-16.1. The department shall provide for the imposition
				of incrementally more severe remedies for repeated, uncorrected, or pervasive
				deficiencies or deficiencies presenting a threat to the health, safety, or
				welfare of residents.
3. The
				provisions of 42 U.S.C.
				1396 r(h)(6) govern the imposition of
				remedies when the department and the regional office do not agree.
4. Enforcement action must cease upon
				recommendation of the survey agency indicating the conditions or circumstances
				causing a deficiency appear to be corrected.
General Authority: NDCC
					 50-24.1-04
Law Implemented:
					 42 USC
					 1396
					 r(h)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-06 - Notice of enforcement action - Delivery or mailing-Posting

Current through Supplement No. 393, July, 2024
1. A written notice of enforcement action
				issued by the department must be hand delivered or mailed to the facility
				owner, administrator, or head of the facility's governing board. The notice
				must include:
a. The basis for the decision;
b. A statement of the deficiencies
				upon which the decision was based; and
c. If the facility is also participating or
				seeking to participate in medicare as a skilled nursing facility, and the basis
				for the department's denial or termination of participation in medicaid is also
				a basis for denial or termination in medicare:
(1) That the appeals procedures specified for
				medicare facilities in 42 CFR part 498 apply; and
(2) A final decision entered under the
				medicare appeals procedure is binding on the department.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-07 - Prohibition on submission of claims through other providers

Current through Supplement No. 393, July, 2024
A facility subject to termination from participation or to
				  any limitation or denial of payment may not submit claims for payment, either
				  directly or indirectly through any clinic, group, corporation, or other
				  association, to the department or any fiscal agent for any services or supplies
				  provided under the medical services program except for any services or supplies
				  provided prior to the effective date of an enforcement action.
General Authority: NDCC
					 50-24.1-04
Law Implemented:
					 42 USC
					 1396
					 r(h)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-08 - Appeals

Current through Supplement No. 393, July, 2024
1. A nonstate-owned facility, participating
				only in medicaid, dissatisfied with an informal dispute resolution decision of
				the survey agency may appeal the issue of whether or not a deficiency occurred
				in the manner provided in section
				75-01-03-20. Correction of the
				deficiency may not be used as a reason for appealing a decision.
2. A facility not entitled to appeal under
				subsection 1 may appeal under 42 CFR part 498.
General Authority: NDCC
					 50-24.1-04
Law Implemented:
					 42 USC
					 1396
					 r(h)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-05.2 - Nursing Facility Enforcement Action › Section 75-02-05.2-09 - Application

Current through Supplement No. 393, July, 2024
The department is responsible for the application of this
				  chapter to nonstate-operated nursing facilities participating only in the
				  medicaid program. The department may make recommendations to the regional
				  office for the application of this chapter to other nursing facilities. This
				  chapter must be applied on or after July 1, 1995.
General Authority: NDCC
					 50-24.1-04
Law Implemented:
					 42 USC
					 1396
					 r(h)
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 75-02-06-01 - 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 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 centers for Medicare and Medicaid services skilled nursing
				facility market basket index four-quarter moving average percent change for
				quarter two of the applicable rate year from the current market basket data
				file publicly available as of August thirty-first of the year preceding the
				rate year. The adjustment factor also shall include any legislatively approved
				inflation increase for nursing facilities.
4. "Admission" means any time a resident is
				admitted to the facility from an outside location, including readmission
				resulting from a discharge.
5.
				"Allowable cost" means the facility's actual cost after appropriate adjustments
				as required by medical assistance regulations.
6. "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 3 of section
				75-02-06-07;
b. A sale and leaseback to the same
				licensee;
c. A transfer of an
				interest to a trust;
d. Gifts or
				other transfers for nominal or no consideration;
e. A merger of two or more related
				organizations;
f. A change in the
				legal form of doing business;
g.
				The addition or deletion of a partner, owner, or shareholder; or
h. 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 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-02 - 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.
				When 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 this chapter and
				HCFA-15 paragraphs 2150 and 2153.
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 or to the secretary of health and
				human services or representatives of the secretary.
d. Except for motor vehicles used exclusively
				for resident-related activities, the provider shall maintain a mileage log for
				all motor vehicles which 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 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-02.1 - 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 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-02.2 - Direct care costs

Current through Supplement No. 393, July, 2024
Direct care costs include only those costs identified in this
				  section.
1.
Therapies.
a. Salary and employment benefits for speech,
				occupational, and physical therapists, or for personnel, who are not reported
				in subsection 2, performing therapy under the direction of a licensed
				therapist.
b. The cost of
				noncapitalized therapy equipment or supplies used to directly provide
				therapy.
c. Training required to
				maintain licensure, certification, or professional standards, and the related
				travel costs.
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 75-02-06-02.3 - Other direct care costs

Current through Supplement No. 393, July, 2024
Other direct care costs include only those costs identified
				  in this section.
1. The cost of
				consumable food products.
2.
				Dietary supplements, including supplements used for tube feedings such as
				elemental high nitrogen diet.
3.
				Laundry costs:
a. Salary and employment
				benefits for a director of laundry, laundry aides, seamstresses, and other
				people who gather, transport, sort, and clean linen and clothing.
b. The cost of laundry supplies including
				detergents, softeners, and linens.
c. Contracted services for laundry.
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 75-02-06-02.4 - 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.
Direct costs for administering the overall
				activities of the facility include:
a. Salary
				and employment benefits for administrators, except in a facility of sixty or
				fewer beds, 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 and receptionists, data processing personnel,
				purchasing, receiving, and store personnel, medical director, security
				personnel, and 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, other 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 and telegraph.
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 except as provided for in section 75-02-06-06.1.
l. Advertising and personnel recruitment
				costs.
m. Management consultants
				and fees.
n. Bad debts and
				collection fees as provided for in section 75-02-06-10.
o. Business meetings, conventions,
				association meetings, and seminars.
p. Travel, except as necessary for training
				programs for personnel required to maintain licensure, certification, or
				professional standards requirements.
q. Training, except for training for
				personnel required to maintain licensure, certification, or professional
				standards requirements.
r. Business
				office functions.
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 75-02-06 - Ratesetting for Nursing Home Care › Section 75-02-06-02.5 - Property costs and other passthrough costs

Current through Supplement No. 393, July, 2024
Property-related costs and other passthrough 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 75-02-06-09.
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 January 1,
				1990, regarding a rate year beginning on or after January 1, 1990;
b. Related to legal services furnished on or
				after January 1, 1990; 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 expenses paid.
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 75-02-06-03 - Depreciation

Current through Supplement No. 393, July, 2024
1. Ratesetting principles require that
				payment for services includes depreciation on all capital assets used to
				provide necessary services.
a. Capital assets
				that may have been fully or partially depreciated on the books of the provider,
				but are in use at the time the provider enters the program, may be depreciated.
				The useful lives of such assets are considered not to have ended and
				depreciation calculated on the revised extended useful life is allowable. To
				properly provide for costs or the valuation of such assets, an appraisal is
				required if the provider has no historical cost records or has incomplete
				records of the capital assets.
b. A
				depreciation allowance is permitted on assets used in a normal standby or
				emergency capacity.
c. If any
				depreciated personal property asset is sold or disposed of for an amount
				different than its undepreciated value, the difference represents an incorrect
				allocation of the cost of the asset to the facility and must be included as a
				gain or loss on the cost report. The facility shall use the sale price in
				computing the gain or loss on the disposition of assets.
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 75-02-06-04 - Interest expense

Current through Supplement No. 393, July, 2024
1. To be allowable,
				interest expense must meet all of the following criteria:
a. Interest expense must be supported by
				evidence of an agreement that funds were borrowed and that payment of interest
				and repayment of the funds are required.
b. Interest expense must be identifiable in
				the facility's accounting records.
c. Interest expense must be related to the
				reporting period in which the costs are incurred.
d. Interest expense must be necessary and
				proper for the operation, maintenance, or acquisition of the facility.
e. Interest expense must not
				relate to funds borrowed to finance costs of assets in excess of the
				depreciable cost basis established at the time of purchase, construction, or
				renovation, as recognized under the provisions of section
				75-02-06-03.
f. If associated with borrowing for the
				purpose of acquiring assets as an ongoing operation in a bona fide sale,
				interest expense must be limited to the amount of interest associated with
				borrowing, occurring at the time of the sale, that does not exceed ninety
				percent of the cost basis, as determined in section
				75-02-06-03.
g. In a sale not bona fide, interest expense
				may not exceed the amount that would have been allowable had the sale not
				occurred.
h. If associated with
				refinancing or refunding debt, interest expense associated with the original
				borrowing must have been allowable when the debt was initially incurred.
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 75-02-06-04.1 - Funded depreciation

Current through Supplement No. 393, July, 2024
1. Funding
				of depreciation is the practice of placing funds, including nonborrowed bond
				reserve and sinking funds, in a segregated account for the acquisition of
				capital assets used in rendering resident care or for other capital purposes
				related to resident care. Other capital purposes include capital debt
				liquidation, such as principal payments for bonds and mortgages.
2. All provisions of this subsection must be
				met in order to qualify as funding of depreciation. If the provisions are not
				met, income earned on investments must be offset to interest expense.
a. The action to fund depreciation must be
				approved by the appropriate managing body of the facility.
b. The fund or funds must be clearly
				designated in the facility's records as funded depreciation accounts.
c. The total market value of the
				funded depreciation fund, including loans made pursuant to subsection 5, must
				be available, unless contractually committed as provided in subsection 8 or 9,
				on an as-needed basis for the acquisition of the facility's capital assets used
				to render resident care, or for other capital purposes related to resident
				care. Loans made from funded depreciation do not alter the requirement that
				funded depreciation must be available.
d. Income earned on investments in the fund
				must be deposited in and become part of the funded depreciation account.
e. Deposits to the funded
				depreciation account must remain for six months or more to be considered as
				funded depreciation. Deposits of less than six months are not eligible for the
				benefits of the funded depreciation account. Investment income earned prior to
				elapse of the six-month period may not be offset unless the deposits are
				actually withdrawn and then only if the withdrawal is not for capital purposes.
f. Funded depreciation may not be
				restricted for a specific or future purpose.
g. When a provider invests or transfers the
				assets of the fund to a home office of a chain organization, or the motherhouse
				or governing body of a religious order or to other related parties, the assets
				are considered to be the facility's funds and are subject to all provisions of
				this section.
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 75-02-06-05 - Compensation

Current through Supplement No. 393, July, 2024
1. Compensation on an annual basis for top
				management personnel must be limited, prior to allocation, if any, to the
				highest market-driven compensation of an administrator employed by a
				freestanding facility, with licensed capacity, during the previous report year,
				at least equal to the licensed capacity of the smallest facility within the top
				quartile of all facilities ranked by licensed capacity, increased by the
				consumer price index for all urban consumers (all items, United States city
				average). Compensation for top management personnel employed for less than a
				year must be limited to an amount equal to the limitation divided by three
				hundred sixty-five times the number of calendar days the individual was
				employed.
2. Compensation includes:
a. Salary for managerial, administrative,
				professional, and other services.
b. Amounts paid for the personal benefits of
				the individual, e.g., housing allowance, flat-rate automobile
				allowance.
c. The cost of assets
				and services the individual receives from the facility.
d. Deferred compensation, pensions, and
				annuities.
e. Supplies and services
				for the personal use of the individual.
f. The cost of a domestic or other employee
				who works in the home of the individual.
g. Life and health insurance premiums paid
				for the individual and medical services furnished at facility
				expense.
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 75-02-06-06 - Return on investment

Current through Supplement No. 393, July, 2024
No return on investment shall be allowed.
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 75-02-06-06.1 - 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 such 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
				nursing or therapies 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 allocated under this section.