North Dakota Administrative Code
Title 75 - Department of Human Services
Article 75-02 - Economic Assistance
Chapter 75-02-06 - Ratesetting for Nursing Home Care
Section 75-02-06-17 - Classifications
Universal Citation: ND Admin Code ยง 75-02-06-17
Current through Supplement No. 394, October, 2024
1. A facility shall complete a resident assessment for any resident occupying a licensed facility bed, except a respite care, hospice inpatient respite care, or hospice general care resident.
2. A resident must be classified in one of forty-eight classifications based on the resident assessment. If a resident assessment is not performed in accordance with subsection 3, except for a respite care, hospice inpatient respite care, or hospice general inpatient care resident, the resident must be included in group AAA, not classified, until the next required resident assessment is performed in accordance with subsection 3. For purposes of determining standardized resident days, any resident day classified as group AAA must be assigned the relative weight of one. A resident, except for a respite care, hospice inpatient respite care, or hospice general inpatient care resident, who has not been classified, must be billed at the group AAA established rate. The case-mix weight for establishing the rate for group AAA is 0.45. Days for a respite care, hospice inpatient respite care, or hospice general inpatient care resident who is not classified must be given a weight of one when determining standardized resident days. Therapeutic, hospital, or institutional leave days that are resident days must be given a weight of 0.45 when determining standardized resident days.
3. Resident assessments must be completed as follows:
a. The facility shall assess the resident
within the first fourteen days after any admission or return from an acute
hospital stay. The assessment reference date must be between day seven and day
fourteen.
b. The facility shall
assess the resident quarterly after any admission or return from an acute
hospital stay. The quarterly assessment reference period ends on the day of the
third subsequent month corresponding to the day of admission or return from an
acute hospital stay, except if that month does not have a corresponding date,
the quarterly assessment reference period ends on the first day of the next
month. The assessment reference period begins seven days prior to the ending
date of a quarterly assessment period. The assessment reference date used for
the resident assessment instrument must be within the assessment reference
period.
c. An assessment must be
submitted upon initiation of rehabilitation therapy if initiation of
rehabilitation therapy occurs outside of the quarterly assessment reference
period established in subdivision b.
d. An assessment must be submitted upon
discontinuation of rehabilitation therapy if discontinuation of rehabilitation
therapy occurs outside of the quarterly assessment reference period established
in subdivision b.
4. The resident classification is based on resident characteristics and health status recorded on the resident assessment instrument, including the ability to perform activities of daily living, diagnoses, and treatment received. The resident is first classified in one of seven major categories. The resident is then classified into subdivisions of each major category based on the resident's activities of daily living score and whether nursing rehabilitation services are needed or the resident has signs of depression.
5. For purposes of this section:
a. A resident's activities of daily living
score used in determining the resident's classification is based on the amount
of assistance, as described in the resident assessment instrument, the resident
needs to complete the activities of bed mobility, transferring, toileting, and
eating;
b. A resident has a need
for nursing rehabilitation services if the resident receives two or more of the
following for at least fifteen minutes per day for at least six of the seven
days preceding the assessment:
(1) Passive or
active range of motion;
(2)
Amputation or prosthesis care;
(3)
Splint or brace assistance;
(4)
Dressing or grooming training;
(5)
Eating or swallowing training;
(6)
Bed mobility or walking training;
(7) Transfer training;
(8) Communication training; or
(9) Urinary toileting, bladder, or bowel
training program; and
c.
A resident has signs of depression if the resident's total severity score for
depression is at least ten based on the following:
(1) Little interest or pleasure in doing
things;
(2) Feeling down,
depressed, or hopeless;
(3) Trouble
falling asleep or staying asleep or sleeping too much;
(4) Feeling tired or having little
energy;
(5) Poor appetite or
overeating;
(6) Feeling bad or
failure or let self or others down;
(7) Trouble concentrating on
things;
(8) Moving or speaking
slowly or being fidgety or restless;
(9) Thoughts of being better off dead or
hurting self; or
(10)
Short-tempered or easily annoyed.
6. The major categories in hierarchical order are:
a. Rehabilitation category. To qualify
for the rehabilitation category, a resident must receive rehabilitation
therapy. A resident who qualifies for the rehabilitation category is assigned a
subcategory based on the resident's activities of daily living score. The
rehabilitation category may be assigned within a classification period based on
initiation or discontinuation dates if therapies are begun or discontinued on
any date not within an assessment reference period.
b. Extensive services category. To qualify
for the extensive services category, a resident must have an activities of
daily living score of at least two and within the fourteen days preceding the
assessment, received tracheostomy care or required a ventilator or respirator
while a resident.
c. Special care
high category.
(1) To qualify for the special
care high category, a resident must have at least one of the following
conditions or treatments with an activities of daily living score of at least
two:
(a) Comatose and completely dependent
for activities of daily living;
(b)
Septicemia;
(c) Diabetes with:
[1] Insulin injections seven days a week; and
[2] Insulin order changes on two
or more days;
(d)
Quadriplegia with an activities of daily living score of at least
five;
(e) Chronic obstructive
pulmonary disease and shortness of breath when lying flat;
(f) A fever in combination with:
[1] Pneumonia;
[2] Vomiting;
[3] Weight loss; or
[4] Tube feedings while a resident that
comprise at least:
[a] Twenty-six percent of
daily caloric requirements and at least five hundred and one milliliters of
fluid through the tube per day; or
[b] Fifty-one percent of daily caloric
requirements;
(g) Parenteral or intravenous feedings
provided in and administered in and by the nursing facility; or
(h) Respiratory therapy seven days a
week.
(2) A resident who
qualifies for the special care category is assigned a subcategory based on the
resident's activities of daily living score and whether the resident has signs
of depression.
d.
Special care low category.
(1) To qualify for
the special care low category, a resident must have at least one of the
following conditions or treatments with an activities of daily living score of
at least two:
(a) Multiple sclerosis, cerebral
palsy, or Parkinson's disease with an activities of daily living score of at
least five;
(b) Respiratory failure
and oxygen therapy while a resident administered continuously for at least two
hours or intermittently with at least two applications of at least thirty
minutes each within the facility in the fourteen days preceding the
assessment;
(c) Tube feedings while
a resident that comprise at least:
[1]
Twenty-six percent of daily caloric requirements and at least five hundred and
one milliliters of fluid through the tube per day; or
[2] Fifty-one percent of daily caloric
requirements.
(d) Two or
more stage two pressure ulcers with two or more skin treatments;
(e) Stage three or four pressure ulcer with
two or more skin treatments;
(f)
Two or more venous or arterial ulcers with two or more skin
treatments;
(g) One stage two
pressure ulcer and one venous or arterial ulcer with two or more skin
treatments;
(h) Foot infection,
diabetic foot ulcer, or other open lesion of foot with application of dressings
to the foot;
(i) Radiation
treatment while a resident; or
(j)
Dialysis treatment while a resident.
(2) A resident who qualifies for the special
care low category is assigned a subcategory based on the resident's activities
of daily living score and whether the resident has signs of
depression.
e.
Clinically complex category.
(1) To qualify
for the clinically complex category, a resident must have one or more of the
conditions for the extensive services or special care categories with an
activities of daily living score of zero or one or have at least one of the
following conditions, treatments, or circumstances:
(a) Pneumonia;
(b) Hemiplegia or hemiparesis with an
activities of daily living score of at least five;
(c) Surgical wounds or open lesions with at
least one skin treatment;
(d)
Burns;
(e) Chemotherapy while a
resident;
(f) Oxygen therapy while
a resident administered continuously for at least two hours or intermittently
with at least two applications of at least thirty minutes each within the
facility in the fourteen days preceding the assessment;
(g) Intravenous medication provided,
instilled, and administered by staff within the facility while a resident;
or
(h) Transfusions while a
resident.
(2) A resident
who qualifies for the clinically complex category is assigned a subcategory
based on the resident's activities of daily living score and whether the
resident has signs of depression.
f. Behavioral symptoms and cognitive
performance category. To qualify for the behavioral symptoms and cognitive
performance category, a resident must have an activities of daily living score
of less than six.
(1) To qualify for the
behavioral symptoms and cognitive performance category, a resident must either:
(a) Be cognitively impaired based on one of
the following:
[1] A brief interview of mental
status score of less than ten;
[2]
Coma and completely dependent for activities of daily living;
[3] Severely impaired cognitive skills;
or
[4] Have a severe problem being
understood or severe cognitive skills problem and two or more of the following:
[a] Problem being understood;
[b] Short-term memory problem; or
[c] Cognitive skills problem.
(b) Exhibit behavioral
symptoms with one or more of the following symptoms:
[1] Hallucinations;
[2] Delusions;
[3] Physical or verbal behavior symptoms
directed toward others on at least four days in the seven days preceding the
assessment;
[4] Other behavioral
symptoms not directed toward others on at least four days in the seven days
preceding the assessment;
[5]
Rejection of care on at least four days in the seven days preceding the
assessment; or
[6] Wandering on at
least four days in the seven days preceding the assessment.
(2) A resident who
qualifies for the behavioral symptoms and cognitive performance category is
assigned a subcategory based on the resident's activities of daily living score
and the resident's need for nursing rehabilitation services.
g. Reduced physical functioning
category. To qualify for the reduced physical functioning category, a resident
may not qualify for any other group. A resident who qualifies for the reduced
physical functioning category is assigned a subcategory based on the resident's
activities of daily living score and the resident's need for nursing
rehabilitation services.
7. Except as provided in subsection 2, each resident must be classified into a case-mix class with the corresponding group label, activities of daily living score, other criteria, and case-mix weight as follows:
a. Rehabilitation with an activities
of daily living score of fifteen or sixteen (group RAE); case-mix weight:
1.65.
b. Rehabilitation with an
activities of daily living score between eleven and fourteen, inclusive (group
RAD); case-mix weight: 1.58.
c.
Rehabilitation with an activities of daily living score between six and ten,
inclusive (group RAC); case-mix weight: 1.36.
d. Rehabilitation with an activities of daily
living score between two and five, inclusive (group RAB); case-mix weight:
1.10.
e. Rehabilitation with an
activities of daily living score of zero or one (group RAA); case-mix weight:
0.82.
f. Extensive services with an
activities of daily living score of at least two and received tracheostomy care
and ventilator or respirator care (group ES3); case-mix weight: 3.00.
g. Extensive services with an activities of
daily living score of at least two and received tracheostomy, ventilator, or
respirator care (group ES2); case-mix weight: 2.23.
h. Extensive services with an activities of
daily living score of at least two and required infection isolation (group
ES1); case-mix weight: 2.22.
i.
Special care high with depression and an activities of daily living score of
fifteen or sixteen (group HE2); case-mix weight: 1.88.
j. Special care high with an activities of
daily living score of fifteen or sixteen (group HE1); case-mix weight:
1.47.
k. Special care high with
depression and an activities of daily living score between eleven and fourteen,
inclusive (group HD2); case-mix weight: 1.69.
l. Special care high with an activities of
daily living score between eleven and fourteen, inclusive (group HD1); case-mix
weight: 1.33.
m. Special care high
with depression and an activities of daily living score between six and ten,
inclusive (group HC2); case-mix weight: 1.57.
n. Special care high with an activities of
daily living score between six and ten, inclusive (group HC1); case-mix weight:
1.23.
o. Special care high with
depression and an activities of daily living score between two and five,
inclusive (group HB2); case-mix weight: 1.55.
p. Special care high with an activities of
daily living score between two and five, inclusive (group HB1); case-mix
weight: 1.22.
q. Special care low
with depression and an activities of daily living score of fifteen or sixteen
(group LE2); case-mix weight: 1.61.
r. Special care low with an activities of
daily living score of fifteen or sixteen (group LE1); case-mix weight:
1.26.
s. Special care low with
depression and an activities of daily living score between eleven and fourteen,
inclusive (group LD2); case-mix weight: 1.54.
t. Special care low with an activities of
daily living score between eleven and fourteen, inclusive (group LD1); case-mix
weight: 1.21.
u. Special care low
with depression and an activities of daily living score between six and ten,
inclusive (group LC2); case-mix weight: 1.30.
v. Special care low with an activities of
daily living score between six and ten, inclusive (group LC1); case-mix weight:
1.02.
w. Special care low with
depression and an activities of daily living score between two and five,
inclusive (group LB2); case-mix weight: 1.21.
x. Special care low with an activities of
daily living score between two and five, inclusive (group LB1); case-mix
weight: 0.95.
y. Clinically complex
with depression and an activities of daily living score of fifteen or sixteen
(group CE2); case-mix weight: 1.39.
z. Clinically complex with an activities of
daily living score of fifteen or sixteen (group CE1); case-mix weight:
1.25.
aa. Clinically complex with
depression and an activities of daily living score between eleven and fourteen,
inclusive (group CD2); case-mix weight: 1.29.
bb. Clinically complex with an activities of
daily living score between eleven and fourteen, inclusive (group CD1); case-mix
weight: 1.15.
cc. Clinically
complex with depression and an activities of daily living score between six and
ten, inclusive (group CC2); case-mix weight: 1.08.
dd. Clinically complex with an activities of
daily living score between six and ten, inclusive (group CC1); case-mix weight:
0.96.
ee. Clinically complex with
depression and an activities of daily living score between two and five,
inclusive (group CB2); case-mix weight: 0.95.
ff. Clinically complex and an activities of
daily living score between two and five, inclusive (group CB1); case-mix
weight: 0.85.
gg. Clinically
complex with depression and an activities of daily living score of zero or one
(group CA2); case-mix weight: 0.73.
hh. Clinically complex and an activities of
daily living score of zero or one (group CA1); case-mix weight: 0.65.
ii. Behavioral symptoms and cognitive
performance with nursing rehabilitation and an activities of daily living score
between two and five, inclusive (group BB2); case-mix weight: 0.81.
jj. Behavioral symptoms and cognitive
performance with an activities of daily living score between two and five,
inclusive (group BB1); case-mix weight: 0.75.
kk. Behavioral symptoms and cognitive
performance with nursing rehabilitation and an activities of daily living score
of zero or one (group BA2); case-mix weight: 0.58.
ll. Behavioral symptoms and cognitive
performance with an activities of daily living score of zero or one (group
BA1); case-mix weight: 0.53.
mm.
Reduced physical functioning with nursing rehabilitation and an activities of
daily living score of fifteen or sixteen, (group PE2); case-mix weight:
1.25.
nn. Reduced physical
functioning with an activities of daily living score of fifteen or sixteen,
(group PE1); case-mix weight: 1.17.
oo. Reduced physical functioning with nursing
rehabilitation and an activities of daily living score between eleven and
fourteen, inclusive (group PD2); case-mix weight: 1.15.
pp. Reduced physical functioning with an
activities of daily living score between eleven and fourteen, inclusive (group
PD1); case-mix weight: 1.06.
qq.
Reduced physical functioning with nursing rehabilitation and an activities of
daily living score between six and ten, inclusive (group PC2); case-mix weight:
0.91.
rr. Reduced physical
functioning with an activities of daily living score between six and ten,
inclusive (group PC1); case-mix weight: 0.85.
ss. Reduced physical functioning with nursing
rehabilitation and an activities of daily living score between two and five,
inclusive (group PB2); case-mix weight: 0.70.
tt. Reduced physical functioning with an
activities of daily living score between two and five, inclusive (group PB1);
case-mix weight: 0.65.
uu. Reduced
physical functioning with nursing rehabilitation and an activities of daily
living score of zero or one (group PA2); case-mix weight: 0.49.
vv. Reduced physical functioning with an
activities of daily living score of zero or one (group PA1); case-mix weight:
0.45.
8. The classification is effective the date the resident assessment must be completed in all cases except an admission or for a return from an acute hospital stay. The classification for an admission or for a return is effective the date of the admission or return.
9. A facility complying with any provision of this section that requires a resident assessment must use the minimum data set in a resident assessment instrument that conforms to standards for a resident classification system described in 42 CFR 413.333.
General Authority: NDCC 50-24.1-04, 50-24.4-02
Law Implemented: NDCC 50-24.4; 42 USC 1396a(a)(13)
Disclaimer: These regulations may not be the most recent version. North Dakota may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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