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<![CDATA[CHAPTER 50-24.4NURSING HOME RATES50-24.4-01. Definitions. For the purposes of this chapter:1."Actual allowable historical operating cost per diem" means the per diem operating<br>costs allowed by the department for the most recent reporting year.2."Actual resident day" means a billable, countable day as defined by the department.3."Department" means the department of human services.4."Depreciable equipment" means the standard movable resident care equipment and<br>support service equipment generally used in long-term care facilities.5."Direct care costs" means the cost category for allowable nursing and therapy costs.6."Final rate" means the rate established after any adjustment by the department,<br>including adjustments resulting from cost report reviews and audits.7."Fringe benefits" means workforce safety and insurance, group health or dental<br>insurance, group life insurance, retirement benefits or plans, and uniform<br>allowances, and medical services furnished at nursing home expense.8."General and administrative costs" means all allowable costs for administering the<br>facility, including salaries of administrators, assistant administrators, accounting<br>personnel, data processing personnel, security personnel, and all clerical personnel;<br>board of directors' fees; business office functions and supplies; travel, except as<br>necessary for training programs for dietitians, nursing personnel, and direct resident<br>care related personnel required to maintain licensure, certification, or professional<br>standards requirements; telephone and telegraph; advertising; membership dues<br>and subscriptions; postage; insurance, except as included as a fringe benefit;<br>professional services such as legal, accounting, and data processing services;<br>central or home office costs; management fees; management consultants;<br>employee training, for any top management personnel and for other than direct<br>resident care related personnel; and business meetings and seminars.9."Historical operating costs" means the allowable operating costs incurred by the<br>facility during the reporting year immediately preceding the rate year for which the<br>payment rate becomes effective, after the department has reviewed those costs and<br>determined them to be allowable costs under the medical assistance program, and<br>after the department has applied appropriate limitations such as the limit on<br>administrative costs.10."Indirect care costs" means the cost category for allowable administration, plant,<br>housekeeping, medical records, chaplain, pharmacy, and dietary, exclusive of food<br>costs.11."Managed care organization" means a medicaid managed care organization as that<br>term is defined in section 1903(m) of the Social Security Act [42 U.S.C. 1396b(m)].12."Nursing home" means a facility, not owned or administered by the state<br>government, defined in section 43-34-01 or a facility owned or administered by the<br>state, which agrees to accept a rate established under this chapter.13."Operating costs" means the day-to-day costs of operating the facility in compliance<br>with licensure and certification standards.Page No. 114."Other direct care costs" means the cost category for allowable activities, social<br>services, laundry, and food costs.15."Payment rate" means the rate determined under section 50-24.4-06.16."Payroll taxes" means the employer's share of Federal Insurance Contributions Act<br>taxes, governmentally required retirement contributions, and state and federal<br>unemployment compensation taxes.17."Private-paying resident" means a nursing home resident on whose behalf the<br>nursing home is not receiving medical assistance payments and whose payment<br>rate is not established by any governmental entity with ratesetting authority,<br>including the veterans' administration or medicare, or whose payment rate is not<br>negotiated by any managed care organization contracting with a facility to provide<br>services for the resident.18."Rate year" means the fiscal year for which a payment rate determined under this<br>chapter is effective, from January first to the next December thirty-first.19."Real estate" means improvements to real property and attached fixtures used<br>directly for resident care.20."Reporting year" means the period from July first to June thirtieth, immediately<br>preceding the rate year, for which the nursing home submits reports required under<br>this chapter.21."Top management personnel" means owners, board members, corporate officers,<br>general,regional,anddistrictmanagers,administrators,nursinghomeadministrators, and other persons performing functions ordinarily performed by such<br>personnel.50-24.4-01.1.Nursing home resident payment classifications - Procedures forreconsideration.1.For purposes of this section, "resident's representative" includes the resident's<br>guardian or conservator, a person authorized or required to pay the nursing home<br>expenses of the resident, or any other person designated by the resident in writing.2.The department shall establish resident payment classifications for the care of<br>residents of nursing homes.3.The department shall assign nursing home residents to the appropriate payment<br>classification based upon assessments of the residents.4.The department shall notify each resident, and the nursing home in which the<br>resident resides, of the payment classification established under subsection 3. The<br>notice must inform the resident of the classification that was assigned, the<br>opportunity to review the documentation supporting the classification, the opportunity<br>to obtain clarification from the department, and the opportunity to appeal the<br>classification. The notice of resident classification must be sent by first-class mail.<br>The individual resident notices may be sent to the resident's nursing home for<br>distribution to the resident in which event the nursing home is responsible for the<br>distribution of the notice to the resident and to the resident's representative, if any.<br>This notice must be distributed to the resident and sent first-class mail or<br>hand-delivered to the resident's representative within three working days after the<br>nursing home's receipt of the notice from the department.5.The resident or the nursing home may appeal the assigned payment classification to<br>the department. The appeal must be submitted in writing to the department withinPage No. 2thirty days of the receipt of the notice of resident classification.For appealssubmitted by or on behalf of the resident, the time period for submission of the<br>request begins on the date the classification notice is delivered to the resident, or<br>mailed or delivered to the resident's representative, whichever is latest. The appeal<br>must be accompanied by the name of the resident, the name and address of the<br>nursing home in which the resident resides, the reasons for the appeal, the<br>requested classification changes, and documentation supporting the requested<br>classification.The documentation accompanying the appeal is limited todocumentation intended to establish that the needs of the resident, at the time of the<br>assessment resulting in the disputed classification, justify a change of classification.6.Upon written request, the nursing home shall give the resident or the resident's<br>representative a copy of the assessment form and the other documentation that was<br>given to the department to support the assessment findings. The nursing home<br>shall also provide access to and a copy of other information from the resident's<br>record that has been requested by or on behalf of the resident to support a resident's<br>appeal. A copy of any requested material must be provided within three working<br>days of receipt of a written request for the information. Upon request, the nursing<br>home shall assist the resident in preparing an appeal.7.In addition to the information required in subsection 5, an appeal by a nursing home<br>must be accompanied by the following information: the date the resident payment<br>classification notices were received by the nursing home; the date the classification<br>notices were distributed to the resident or the resident's representative; and a copy<br>of a notice of appeal sent to the resident or to the resident's representative. This<br>notice must tell the resident or the resident's representative that the resident's<br>classification is being appealed, the reason for the appeal, that the resident's rate<br>will change if the appeal is approved by the department and the extent of the<br>change, that copies of the nursing home's appeal and supporting documentation are<br>available for review, and that the resident also has the right to appeal. If the nursing<br>home fails to provide this information with the appeal, the appeal must be denied,<br>and the nursing home may not make further appeals concerning that specific<br>resident payment classification until such time as the resident's payment<br>classification is reestablished by the department.8.The appeal determination of the department must be made by individuals not<br>involved in reviewing the assessment that established the disputed classification.<br>The appeal determination must be based upon the initial assessment and upon the<br>information provided to the department under subsection 5.If the departmentdetermines that it is necessary for the appeal determination, it may conduct onsite<br>reviews. Within fifteen working days of receiving the appeal, the department shall<br>affirm or modify the original resident classification. The original classification must<br>be modified if the department determines that the assessment resulting in the<br>classification did not accurately reflect the needs of the resident at the time of the<br>assessment. The resident and the nursing home must be notified within five working<br>days after the decision is made.9.The appeal determination under subsection 8 is the final administrative decision of<br>the agency. That decision is subject to appeal to the district court, and for that<br>purpose, the decision must be treated as a decision on a petition for rehearing made<br>pursuant to section 28-32-40.Appeal to the district court must be taken in themanner required by section 28-32-42.50-24.4-02.Authority.The department shall establish, by rule, procedures fordetermining rates for care of residents of nursing homes which qualify as vendors of medical<br>assistance and for implementing the provisions of this chapter. The procedures must be based<br>on methods and standards which the department finds are adequate to recognize the costs that<br>must be incurred for the care of residents in efficiently and economically operated nursing<br>homes. The department shall identify costs that are recognized for establishing payment rates.Page No. 350-24.4-03. Federal requirements - Supremacy. If any provision of this chapter isdetermined by the United States government to be in conflict with existing or future requirements<br>of the United States government with respect to federal participation in medical assistance, the<br>federal requirements prevail.50-24.4-04. Payment rates. Payment rates paid to any nursing home receiving medicalassistance payments must be those rates established pursuant to this chapter and rules adopted<br>under it.50-24.4-05.Requirements.No medical assistance payments may be made to anynursing home unless the nursing home is certified to participate in the medical assistance<br>program under title XIX of the federal Social Security Act and has in effect a provider agreement<br>with the department meeting the requirements of state and federal statutes and rules.Nomedical assistance payments may be made to any nursing home unless the nursing home<br>complies with all requirements of North Dakota law including, but not limited to, this chapter and<br>rules adopted under it that govern participation in the program. This section applies whether the<br>nursing home participates fully in the medical assistance program or is withdrawing from the<br>medical assistance program.50-24.4-06. Rate determination.1.The department shall determine prospective payment rates for resident care costs.<br>The department shall develop procedures for determining operating cost payment<br>rates that take into account the mix of resident needs and other factors as<br>determined by the department.2.The department shall establish, by rule, limitations on compensation recognized in<br>the historical base for top management personnel.Compensation for topmanagement personnel must be categorized as a general and administrative cost<br>and is subject to any limits imposed on that cost category.3.For purposes of determining rates, the department shall:a.Include, contingent upon approval of the medicaid state plan by the centers for<br>medicare and medicaid services, allowable bad debt expenses in an amount<br>not to exceed one hundred eighty days of resident care per year or an<br>aggregate of three hundred sixty days of resident care for any one individual;<br>andb.Include allowable bad debt expenses in the property cost category in the report<br>year in which the bad debt is determined to be uncollectible with no likelihood of<br>future recovery.50-24.4-07. Nonallowable costs.1.The following costs may not be recognized as allowable:political contributions;salaries or expenses of a lobbyist, as defined in section 54-05.1-02, for lobbying<br>activities; advertising designed to encourage potential residents to select a particular<br>nursing home; fines and penalties; legal and related expenses for unsuccessful<br>challenges to decisions by governmental agencies; memberships in sports, health,<br>or similar social clubs or organizations; and costs incurred for activities directly<br>related to influencing employees with respect to unionization. The department by<br>rule shall exclude the costs of other items or services not directly related to the<br>provision of resident care.2.Nonallowable costs include the education expense unless:a.The education was provided by an accredited academic or technical<br>educational facility;Page No. 4b.The education expense was for materials, books, or tuition;c.The facility claims the education expense, annually, in an amount not to exceed<br>the lesser of one-half of the individual's education expense or three thousand<br>seven hundred fifty dollars; andd.The amount of education expense claimed for an individual does not exceed<br>fifteen thousand dollars in the aggregate.3.The education expense may be claimed the year in which it is expended.4.For any individual who receives education assistance, the facility shall enter a<br>contract with the individual which stipulates a minimum commitment to work for the<br>facility as well as a repayment plan if the individual does not fulfill the contract<br>obligations.5.An individual who receives education assistance shall commit to a minimum of one<br>thousand six hundred sixty-four hours of employment after completion of the<br>educational program for each year education assistance was provided by the facility.6.The facility shall report the education expense separately on the facility's cost report.<br>The expense is allowed as a passthrough and is limited only by the fifteen thousand<br>dollar maximum per individual.7.If an individual defaults on a contract and education expenses for the individual have<br>previously been claimed in any report year, the facility shall report the amount of<br>repayment on the facility's cost report in the report year in which the default occurs.50-24.4-08. Notice of increases to private-paying residents. No increase in nursinghome rates for private-paying residents is effective unless the nursing home notifies the resident<br>or person responsible for payment of the increase in writing thirty days before the increase takes<br>effect. A nursing home may adjust its rates without giving the notice required by this section<br>when the purpose of the rate adjustment is to reflect a necessary change in the category of care<br>provided to a resident.If the department fails to set rates at least forty days prior to thebeginning of a rate year, the time required for giving notice is decreased by the number of days<br>by which the department was late in setting the rates, except when a facility fails to file a cost<br>report by October first.50-24.4-09. Interim rates. Repealed by S.L. 2005, ch. 432, <meta property="og:url" content="https://statutes.laws.com/test/" />
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<h2>State Codes and Statutes</h2>
<a href='https://statutes.laws.com/'>Statutes</a> > <a href='https://statutes.laws.com/north-dakota'>North-dakota</a> > <a href='https://statutes.laws.com/north-dakota/t50'>T50</a> > <a href='https://statutes.laws.com/north-dakota/t50/t50c244'>T50c244</a><br><br><a href="https://law.justia.com/codes/north-dakota/2009/t50/pdf/t50c244.pdf">Download pdf</a><br><div id="embed_document" style="width:625px; height:815px; text-align:center;">Loading PDF...</div><script type="text/javascript"> var pdf_url = 'https://law.justia.com/codes/north-dakota/2009/t50/pdf/t50c244.pdf'; $(document).ready(function() { var embedwindow = $("#embed_document"); if ($.browser.msie){ embedwindow.html('<embed src="'+pdf_url+'" width="100%" height="100%"></embed>'); } else { embedwindow.html('<iframe style="width:100%; height:100%;" src="https://docs.google.com/gview?url='+window.escape(pdf_url)+'&embedded=true" frameborder="0"></iframe>'); } });</script><br><br><noframes>CHAPTER 50-24.4NURSING HOME RATES50-24.4-01. Definitions. For the purposes of this chapter:1."Actual allowable historical operating cost per diem" means the per diem operating<br>costs allowed by the department for the most recent reporting year.2."Actual resident day" means a billable, countable day as defined by the department.3."Department" means the department of human services.4."Depreciable equipment" means the standard movable resident care equipment and<br>support service equipment generally used in long-term care facilities.5."Direct care costs" means the cost category for allowable nursing and therapy costs.6."Final rate" means the rate established after any adjustment by the department,<br>including adjustments resulting from cost report reviews and audits.7."Fringe benefits" means workforce safety and insurance, group health or dental<br>insurance, group life insurance, retirement benefits or plans, and uniform<br>allowances, and medical services furnished at nursing home expense.8."General and administrative costs" means all allowable costs for administering the<br>facility, including salaries of administrators, assistant administrators, accounting<br>personnel, data processing personnel, security personnel, and all clerical personnel;<br>board of directors' fees; business office functions and supplies; travel, except as<br>necessary for training programs for dietitians, nursing personnel, and direct resident<br>care related personnel required to maintain licensure, certification, or professional<br>standards requirements; telephone and telegraph; advertising; membership dues<br>and subscriptions; postage; insurance, except as included as a fringe benefit;<br>professional services such as legal, accounting, and data processing services;<br>central or home office costs; management fees; management consultants;<br>employee training, for any top management personnel and for other than direct<br>resident care related personnel; and business meetings and seminars.9."Historical operating costs" means the allowable operating costs incurred by the<br>facility during the reporting year immediately preceding the rate year for which the<br>payment rate becomes effective, after the department has reviewed those costs and<br>determined them to be allowable costs under the medical assistance program, and<br>after the department has applied appropriate limitations such as the limit on<br>administrative costs.10."Indirect care costs" means the cost category for allowable administration, plant,<br>housekeeping, medical records, chaplain, pharmacy, and dietary, exclusive of food<br>costs.11."Managed care organization" means a medicaid managed care organization as that<br>term is defined in section 1903(m) of the Social Security Act [42 U.S.C. 1396b(m)].12."Nursing home" means a facility, not owned or administered by the state<br>government, defined in section 43-34-01 or a facility owned or administered by the<br>state, which agrees to accept a rate established under this chapter.13."Operating costs" means the day-to-day costs of operating the facility in compliance<br>with licensure and certification standards.Page No. 114."Other direct care costs" means the cost category for allowable activities, social<br>services, laundry, and food costs.15."Payment rate" means the rate determined under section 50-24.4-06.16."Payroll taxes" means the employer's share of Federal Insurance Contributions Act<br>taxes, governmentally required retirement contributions, and state and federal<br>unemployment compensation taxes.17."Private-paying resident" means a nursing home resident on whose behalf the<br>nursing home is not receiving medical assistance payments and whose payment<br>rate is not established by any governmental entity with ratesetting authority,<br>including the veterans' administration or medicare, or whose payment rate is not<br>negotiated by any managed care organization contracting with a facility to provide<br>services for the resident.18."Rate year" means the fiscal year for which a payment rate determined under this<br>chapter is effective, from January first to the next December thirty-first.19."Real estate" means improvements to real property and attached fixtures used<br>directly for resident care.20."Reporting year" means the period from July first to June thirtieth, immediately<br>preceding the rate year, for which the nursing home submits reports required under<br>this chapter.21."Top management personnel" means owners, board members, corporate officers,<br>general,regional,anddistrictmanagers,administrators,nursinghomeadministrators, and other persons performing functions ordinarily performed by such<br>personnel.50-24.4-01.1.Nursing home resident payment classifications - Procedures forreconsideration.1.For purposes of this section, "resident's representative" includes the resident's<br>guardian or conservator, a person authorized or required to pay the nursing home<br>expenses of the resident, or any other person designated by the resident in writing.2.The department shall establish resident payment classifications for the care of<br>residents of nursing homes.3.The department shall assign nursing home residents to the appropriate payment<br>classification based upon assessments of the residents.4.The department shall notify each resident, and the nursing home in which the<br>resident resides, of the payment classification established under subsection 3. The<br>notice must inform the resident of the classification that was assigned, the<br>opportunity to review the documentation supporting the classification, the opportunity<br>to obtain clarification from the department, and the opportunity to appeal the<br>classification. The notice of resident classification must be sent by first-class mail.<br>The individual resident notices may be sent to the resident's nursing home for<br>distribution to the resident in which event the nursing home is responsible for the<br>distribution of the notice to the resident and to the resident's representative, if any.<br>This notice must be distributed to the resident and sent first-class mail or<br>hand-delivered to the resident's representative within three working days after the<br>nursing home's receipt of the notice from the department.5.The resident or the nursing home may appeal the assigned payment classification to<br>the department. The appeal must be submitted in writing to the department withinPage No. 2thirty days of the receipt of the notice of resident classification.For appealssubmitted by or on behalf of the resident, the time period for submission of the<br>request begins on the date the classification notice is delivered to the resident, or<br>mailed or delivered to the resident's representative, whichever is latest. The appeal<br>must be accompanied by the name of the resident, the name and address of the<br>nursing home in which the resident resides, the reasons for the appeal, the<br>requested classification changes, and documentation supporting the requested<br>classification.The documentation accompanying the appeal is limited todocumentation intended to establish that the needs of the resident, at the time of the<br>assessment resulting in the disputed classification, justify a change of classification.6.Upon written request, the nursing home shall give the resident or the resident's<br>representative a copy of the assessment form and the other documentation that was<br>given to the department to support the assessment findings. The nursing home<br>shall also provide access to and a copy of other information from the resident's<br>record that has been requested by or on behalf of the resident to support a resident's<br>appeal. A copy of any requested material must be provided within three working<br>days of receipt of a written request for the information. Upon request, the nursing<br>home shall assist the resident in preparing an appeal.7.In addition to the information required in subsection 5, an appeal by a nursing home<br>must be accompanied by the following information: the date the resident payment<br>classification notices were received by the nursing home; the date the classification<br>notices were distributed to the resident or the resident's representative; and a copy<br>of a notice of appeal sent to the resident or to the resident's representative. This<br>notice must tell the resident or the resident's representative that the resident's<br>classification is being appealed, the reason for the appeal, that the resident's rate<br>will change if the appeal is approved by the department and the extent of the<br>change, that copies of the nursing home's appeal and supporting documentation are<br>available for review, and that the resident also has the right to appeal. If the nursing<br>home fails to provide this information with the appeal, the appeal must be denied,<br>and the nursing home may not make further appeals concerning that specific<br>resident payment classification until such time as the resident's payment<br>classification is reestablished by the department.8.The appeal determination of the department must be made by individuals not<br>involved in reviewing the assessment that established the disputed classification.<br>The appeal determination must be based upon the initial assessment and upon the<br>information provided to the department under subsection 5.If the departmentdetermines that it is necessary for the appeal determination, it may conduct onsite<br>reviews. Within fifteen working days of receiving the appeal, the department shall<br>affirm or modify the original resident classification. The original classification must<br>be modified if the department determines that the assessment resulting in the<br>classification did not accurately reflect the needs of the resident at the time of the<br>assessment. The resident and the nursing home must be notified within five working<br>days after the decision is made.9.The appeal determination under subsection 8 is the final administrative decision of<br>the agency. That decision is subject to appeal to the district court, and for that<br>purpose, the decision must be treated as a decision on a petition for rehearing made<br>pursuant to section 28-32-40.Appeal to the district court must be taken in themanner required by section 28-32-42.50-24.4-02.Authority.The department shall establish, by rule, procedures fordetermining rates for care of residents of nursing homes which qualify as vendors of medical<br>assistance and for implementing the provisions of this chapter. The procedures must be based<br>on methods and standards which the department finds are adequate to recognize the costs that<br>must be incurred for the care of residents in efficiently and economically operated nursing<br>homes. The department shall identify costs that are recognized for establishing payment rates.Page No. 350-24.4-03. Federal requirements - Supremacy. If any provision of this chapter isdetermined by the United States government to be in conflict with existing or future requirements<br>of the United States government with respect to federal participation in medical assistance, the<br>federal requirements prevail.50-24.4-04. Payment rates. Payment rates paid to any nursing home receiving medicalassistance payments must be those rates established pursuant to this chapter and rules adopted<br>under it.50-24.4-05.Requirements.No medical assistance payments may be made to anynursing home unless the nursing home is certified to participate in the medical assistance<br>program under title XIX of the federal Social Security Act and has in effect a provider agreement<br>with the department meeting the requirements of state and federal statutes and rules.Nomedical assistance payments may be made to any nursing home unless the nursing home<br>complies with all requirements of North Dakota law including, but not limited to, this chapter and<br>rules adopted under it that govern participation in the program. This section applies whether the<br>nursing home participates fully in the medical assistance program or is withdrawing from the<br>medical assistance program.50-24.4-06. Rate determination.1.The department shall determine prospective payment rates for resident care costs.<br>The department shall develop procedures for determining operating cost payment<br>rates that take into account the mix of resident needs and other factors as<br>determined by the department.2.The department shall establish, by rule, limitations on compensation recognized in<br>the historical base for top management personnel.Compensation for topmanagement personnel must be categorized as a general and administrative cost<br>and is subject to any limits imposed on that cost category.3.For purposes of determining rates, the department shall:a.Include, contingent upon approval of the medicaid state plan by the centers for<br>medicare and medicaid services, allowable bad debt expenses in an amount<br>not to exceed one hundred eighty days of resident care per year or an<br>aggregate of three hundred sixty days of resident care for any one individual;<br>andb.Include allowable bad debt expenses in the property cost category in the report<br>year in which the bad debt is determined to be uncollectible with no likelihood of<br>future recovery.50-24.4-07. Nonallowable costs.1.The following costs may not be recognized as allowable:political contributions;salaries or expenses of a lobbyist, as defined in section 54-05.1-02, for lobbying<br>activities; advertising designed to encourage potential residents to select a particular<br>nursing home; fines and penalties; legal and related expenses for unsuccessful<br>challenges to decisions by governmental agencies; memberships in sports, health,<br>or similar social clubs or organizations; and costs incurred for activities directly<br>related to influencing employees with respect to unionization. The department by<br>rule shall exclude the costs of other items or services not directly related to the<br>provision of resident care.2.Nonallowable costs include the education expense unless:a.The education was provided by an accredited academic or technical<br>educational facility;Page No. 4b.The education expense was for materials, books, or tuition;c.The facility claims the education expense, annually, in an amount not to exceed<br>the lesser of one-half of the individual's education expense or three thousand<br>seven hundred fifty dollars; andd.The amount of education expense claimed for an individual does not exceed<br>fifteen thousand dollars in the aggregate.3.The education expense may be claimed the year in which it is expended.4.For any individual who receives education assistance, the facility shall enter a<br>contract with the individual which stipulates a minimum commitment to work for the<br>facility as well as a repayment plan if the individual does not fulfill the contract<br>obligations.5.An individual who receives education assistance shall commit to a minimum of one<br>thousand six hundred sixty-four hours of employment after completion of the<br>educational program for each year education assistance was provided by the facility.6.The facility shall report the education expense separately on the facility's cost report.<br>The expense is allowed as a passthrough and is limited only by the fifteen thousand<br>dollar maximum per individual.7.If an individual defaults on a contract and education expenses for the individual have<br>previously been claimed in any report year, the facility shall report the amount of<br>repayment on the facility's cost report in the report year in which the default occurs.50-24.4-08. Notice of increases to private-paying residents. No increase in nursinghome rates for private-paying residents is effective unless the nursing home notifies the resident<br>or person responsible for payment of the increase in writing thirty days before the increase takes<br>effect. A nursing home may adjust its rates without giving the notice required by this section<br>when the purpose of the rate adjustment is to reflect a necessary change in the category of care<br>provided to a resident.If the department fails to set rates at least forty days prior to thebeginning of a rate year, the time required for giving notice is decreased by the number of days<br>by which the department was late in setting the rates, except when a facility fails to file a cost<br>report by October first.50-24.4-09. Interim rates. 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<h2>State Codes and Statutes</h2>
<a href='https://statutes.laws.com/'>Statutes</a> > <a href='https://statutes.laws.com/north-dakota'>North-dakota</a> > <a href='https://statutes.laws.com/north-dakota/t50'>T50</a> > <a href='https://statutes.laws.com/north-dakota/t50/t50c244'>T50c244</a><br><br><a href="https://law.justia.com/codes/north-dakota/2009/t50/pdf/t50c244.pdf">Download pdf</a><br><div id="embed_document" style="width:625px; height:815px; text-align:center;">Loading PDF...</div><script type="text/javascript"> var pdf_url = 'https://law.justia.com/codes/north-dakota/2009/t50/pdf/t50c244.pdf'; $(document).ready(function() { var embedwindow = $("#embed_document"); if ($.browser.msie){ embedwindow.html('<embed src="'+pdf_url+'" width="100%" height="100%"></embed>'); } else { embedwindow.html('<iframe style="width:100%; height:100%;" src="https://docs.google.com/gview?url='+window.escape(pdf_url)+'&embedded=true" frameborder="0"></iframe>'); } });</script><br><br><noframes>CHAPTER 50-24.4NURSING HOME RATES50-24.4-01. Definitions. For the purposes of this chapter:1."Actual allowable historical operating cost per diem" means the per diem operating<br>costs allowed by the department for the most recent reporting year.2."Actual resident day" means a billable, countable day as defined by the department.3."Department" means the department of human services.4."Depreciable equipment" means the standard movable resident care equipment and<br>support service equipment generally used in long-term care facilities.5."Direct care costs" means the cost category for allowable nursing and therapy costs.6."Final rate" means the rate established after any adjustment by the department,<br>including adjustments resulting from cost report reviews and audits.7."Fringe benefits" means workforce safety and insurance, group health or dental<br>insurance, group life insurance, retirement benefits or plans, and uniform<br>allowances, and medical services furnished at nursing home expense.8."General and administrative costs" means all allowable costs for administering the<br>facility, including salaries of administrators, assistant administrators, accounting<br>personnel, data processing personnel, security personnel, and all clerical personnel;<br>board of directors' fees; business office functions and supplies; travel, except as<br>necessary for training programs for dietitians, nursing personnel, and direct resident<br>care related personnel required to maintain licensure, certification, or professional<br>standards requirements; telephone and telegraph; advertising; membership dues<br>and subscriptions; postage; insurance, except as included as a fringe benefit;<br>professional services such as legal, accounting, and data processing services;<br>central or home office costs; management fees; management consultants;<br>employee training, for any top management personnel and for other than direct<br>resident care related personnel; and business meetings and seminars.9."Historical operating costs" means the allowable operating costs incurred by the<br>facility during the reporting year immediately preceding the rate year for which the<br>payment rate becomes effective, after the department has reviewed those costs and<br>determined them to be allowable costs under the medical assistance program, and<br>after the department has applied appropriate limitations such as the limit on<br>administrative costs.10."Indirect care costs" means the cost category for allowable administration, plant,<br>housekeeping, medical records, chaplain, pharmacy, and dietary, exclusive of food<br>costs.11."Managed care organization" means a medicaid managed care organization as that<br>term is defined in section 1903(m) of the Social Security Act [42 U.S.C. 1396b(m)].12."Nursing home" means a facility, not owned or administered by the state<br>government, defined in section 43-34-01 or a facility owned or administered by the<br>state, which agrees to accept a rate established under this chapter.13."Operating costs" means the day-to-day costs of operating the facility in compliance<br>with licensure and certification standards.Page No. 114."Other direct care costs" means the cost category for allowable activities, social<br>services, laundry, and food costs.15."Payment rate" means the rate determined under section 50-24.4-06.16."Payroll taxes" means the employer's share of Federal Insurance Contributions Act<br>taxes, governmentally required retirement contributions, and state and federal<br>unemployment compensation taxes.17."Private-paying resident" means a nursing home resident on whose behalf the<br>nursing home is not receiving medical assistance payments and whose payment<br>rate is not established by any governmental entity with ratesetting authority,<br>including the veterans' administration or medicare, or whose payment rate is not<br>negotiated by any managed care organization contracting with a facility to provide<br>services for the resident.18."Rate year" means the fiscal year for which a payment rate determined under this<br>chapter is effective, from January first to the next December thirty-first.19."Real estate" means improvements to real property and attached fixtures used<br>directly for resident care.20."Reporting year" means the period from July first to June thirtieth, immediately<br>preceding the rate year, for which the nursing home submits reports required under<br>this chapter.21."Top management personnel" means owners, board members, corporate officers,<br>general,regional,anddistrictmanagers,administrators,nursinghomeadministrators, and other persons performing functions ordinarily performed by such<br>personnel.50-24.4-01.1.Nursing home resident payment classifications - Procedures forreconsideration.1.For purposes of this section, "resident's representative" includes the resident's<br>guardian or conservator, a person authorized or required to pay the nursing home<br>expenses of the resident, or any other person designated by the resident in writing.2.The department shall establish resident payment classifications for the care of<br>residents of nursing homes.3.The department shall assign nursing home residents to the appropriate payment<br>classification based upon assessments of the residents.4.The department shall notify each resident, and the nursing home in which the<br>resident resides, of the payment classification established under subsection 3. The<br>notice must inform the resident of the classification that was assigned, the<br>opportunity to review the documentation supporting the classification, the opportunity<br>to obtain clarification from the department, and the opportunity to appeal the<br>classification. The notice of resident classification must be sent by first-class mail.<br>The individual resident notices may be sent to the resident's nursing home for<br>distribution to the resident in which event the nursing home is responsible for the<br>distribution of the notice to the resident and to the resident's representative, if any.<br>This notice must be distributed to the resident and sent first-class mail or<br>hand-delivered to the resident's representative within three working days after the<br>nursing home's receipt of the notice from the department.5.The resident or the nursing home may appeal the assigned payment classification to<br>the department. The appeal must be submitted in writing to the department withinPage No. 2thirty days of the receipt of the notice of resident classification.For appealssubmitted by or on behalf of the resident, the time period for submission of the<br>request begins on the date the classification notice is delivered to the resident, or<br>mailed or delivered to the resident's representative, whichever is latest. The appeal<br>must be accompanied by the name of the resident, the name and address of the<br>nursing home in which the resident resides, the reasons for the appeal, the<br>requested classification changes, and documentation supporting the requested<br>classification.The documentation accompanying the appeal is limited todocumentation intended to establish that the needs of the resident, at the time of the<br>assessment resulting in the disputed classification, justify a change of classification.6.Upon written request, the nursing home shall give the resident or the resident's<br>representative a copy of the assessment form and the other documentation that was<br>given to the department to support the assessment findings. The nursing home<br>shall also provide access to and a copy of other information from the resident's<br>record that has been requested by or on behalf of the resident to support a resident's<br>appeal. A copy of any requested material must be provided within three working<br>days of receipt of a written request for the information. Upon request, the nursing<br>home shall assist the resident in preparing an appeal.7.In addition to the information required in subsection 5, an appeal by a nursing home<br>must be accompanied by the following information: the date the resident payment<br>classification notices were received by the nursing home; the date the classification<br>notices were distributed to the resident or the resident's representative; and a copy<br>of a notice of appeal sent to the resident or to the resident's representative. This<br>notice must tell the resident or the resident's representative that the resident's<br>classification is being appealed, the reason for the appeal, that the resident's rate<br>will change if the appeal is approved by the department and the extent of the<br>change, that copies of the nursing home's appeal and supporting documentation are<br>available for review, and that the resident also has the right to appeal. If the nursing<br>home fails to provide this information with the appeal, the appeal must be denied,<br>and the nursing home may not make further appeals concerning that specific<br>resident payment classification until such time as the resident's payment<br>classification is reestablished by the department.8.The appeal determination of the department must be made by individuals not<br>involved in reviewing the assessment that established the disputed classification.<br>The appeal determination must be based upon the initial assessment and upon the<br>information provided to the department under subsection 5.If the departmentdetermines that it is necessary for the appeal determination, it may conduct onsite<br>reviews. Within fifteen working days of receiving the appeal, the department shall<br>affirm or modify the original resident classification. The original classification must<br>be modified if the department determines that the assessment resulting in the<br>classification did not accurately reflect the needs of the resident at the time of the<br>assessment. The resident and the nursing home must be notified within five working<br>days after the decision is made.9.The appeal determination under subsection 8 is the final administrative decision of<br>the agency. That decision is subject to appeal to the district court, and for that<br>purpose, the decision must be treated as a decision on a petition for rehearing made<br>pursuant to section 28-32-40.Appeal to the district court must be taken in themanner required by section 28-32-42.50-24.4-02.Authority.The department shall establish, by rule, procedures fordetermining rates for care of residents of nursing homes which qualify as vendors of medical<br>assistance and for implementing the provisions of this chapter. The procedures must be based<br>on methods and standards which the department finds are adequate to recognize the costs that<br>must be incurred for the care of residents in efficiently and economically operated nursing<br>homes. The department shall identify costs that are recognized for establishing payment rates.Page No. 350-24.4-03. Federal requirements - Supremacy. If any provision of this chapter isdetermined by the United States government to be in conflict with existing or future requirements<br>of the United States government with respect to federal participation in medical assistance, the<br>federal requirements prevail.50-24.4-04. Payment rates. Payment rates paid to any nursing home receiving medicalassistance payments must be those rates established pursuant to this chapter and rules adopted<br>under it.50-24.4-05.Requirements.No medical assistance payments may be made to anynursing home unless the nursing home is certified to participate in the medical assistance<br>program under title XIX of the federal Social Security Act and has in effect a provider agreement<br>with the department meeting the requirements of state and federal statutes and rules.Nomedical assistance payments may be made to any nursing home unless the nursing home<br>complies with all requirements of North Dakota law including, but not limited to, this chapter and<br>rules adopted under it that govern participation in the program. This section applies whether the<br>nursing home participates fully in the medical assistance program or is withdrawing from the<br>medical assistance program.50-24.4-06. Rate determination.1.The department shall determine prospective payment rates for resident care costs.<br>The department shall develop procedures for determining operating cost payment<br>rates that take into account the mix of resident needs and other factors as<br>determined by the department.2.The department shall establish, by rule, limitations on compensation recognized in<br>the historical base for top management personnel.Compensation for topmanagement personnel must be categorized as a general and administrative cost<br>and is subject to any limits imposed on that cost category.3.For purposes of determining rates, the department shall:a.Include, contingent upon approval of the medicaid state plan by the centers for<br>medicare and medicaid services, allowable bad debt expenses in an amount<br>not to exceed one hundred eighty days of resident care per year or an<br>aggregate of three hundred sixty days of resident care for any one individual;<br>andb.Include allowable bad debt expenses in the property cost category in the report<br>year in which the bad debt is determined to be uncollectible with no likelihood of<br>future recovery.50-24.4-07. Nonallowable costs.1.The following costs may not be recognized as allowable:political contributions;salaries or expenses of a lobbyist, as defined in section 54-05.1-02, for lobbying<br>activities; advertising designed to encourage potential residents to select a particular<br>nursing home; fines and penalties; legal and related expenses for unsuccessful<br>challenges to decisions by governmental agencies; memberships in sports, health,<br>or similar social clubs or organizations; and costs incurred for activities directly<br>related to influencing employees with respect to unionization. The department by<br>rule shall exclude the costs of other items or services not directly related to the<br>provision of resident care.2.Nonallowable costs include the education expense unless:a.The education was provided by an accredited academic or technical<br>educational facility;Page No. 4b.The education expense was for materials, books, or tuition;c.The facility claims the education expense, annually, in an amount not to exceed<br>the lesser of one-half of the individual's education expense or three thousand<br>seven hundred fifty dollars; andd.The amount of education expense claimed for an individual does not exceed<br>fifteen thousand dollars in the aggregate.3.The education expense may be claimed the year in which it is expended.4.For any individual who receives education assistance, the facility shall enter a<br>contract with the individual which stipulates a minimum commitment to work for the<br>facility as well as a repayment plan if the individual does not fulfill the contract<br>obligations.5.An individual who receives education assistance shall commit to a minimum of one<br>thousand six hundred sixty-four hours of employment after completion of the<br>educational program for each year education assistance was provided by the facility.6.The facility shall report the education expense separately on the facility's cost report.<br>The expense is allowed as a passthrough and is limited only by the fifteen thousand<br>dollar maximum per individual.7.If an individual defaults on a contract and education expenses for the individual have<br>previously been claimed in any report year, the facility shall report the amount of<br>repayment on the facility's cost report in the report year in which the default occurs.50-24.4-08. Notice of increases to private-paying residents. No increase in nursinghome rates for private-paying residents is effective unless the nursing home notifies the resident<br>or person responsible for payment of the increase in writing thirty days before the increase takes<br>effect. A nursing home may adjust its rates without giving the notice required by this section<br>when the purpose of the rate adjustment is to reflect a necessary change in the category of care<br>provided to a resident.If the department fails to set rates at least forty days prior to thebeginning of a rate year, the time required for giving notice is decreased by the number of days<br>by which the department was late in setting the rates, except when a facility fails to file a cost<br>report by October first.50-24.4-09. Interim rates. Repealed by S.L. 2005, ch. 432, <!-- END .shortcode-content -->
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