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

1. "Activities of daily living" means the daily self-care personal activities that include bathing, dressing or undressing, eating or feeding, toileting, continence, transferring in and out of bed or chair or on and off the toilet, and mobility inside the home.

2. "Adaptive assessment" means an evaluation to identify adaptive devices, equipment, or modifications that enhance the independence and functional capabilities of an individual who may otherwise be unable to remain in the individual's home.

3. "Aged" means sixty-five years of age or older.

4. "Congenital disability" means a disability that exists at birth or shortly thereafter, and is not attributable to a diagnosis of either mental retardation or a closely related condition of mental retardation.

5. "Department" means the North Dakota department of health and human services.

6. "Designee" means a person that enrolls as a qualified service provider to provide case management services for the Medicaid waiver program.

7. "Disability due to trauma" means a disability that results from an injury or assault to the body by an external force.

8. "Disability that is acquired" means a disability that results from an assault that occurs internally within the body.

9. "Disabled" means under age sixty-five with a congenital disability, a disability due to trauma, or a disability that is acquired.

10. "Eligible individual" means an individual who meets the eligibility requirements and is receiving services reimbursed under North Dakota Century Code chapter 50-06.2 or this chapter.

11. "Functional assessment" means an instrument used to record basic demographic and medical information about an individual, including age, date of birth, spoken language, marital status, individuals residing with, emergency contacts, medical resources, health care coverage, and source and reason for referral; and to secure measurable information regarding:

12. "Functional impairment" means the inability to perform, either by oneself or with adaptive aids or with human help, specific activities of daily living or instrumental activities of daily living.

13. "Home and community-based services" means the array of services under the SPED program and Medicaid waiver defined in the comprehensive human service plan and the other services the department determines to be essential and appropriate to sustain individuals in their homes and in their communities, and to delay or prevent institutional care.

14. "Institution" means a hospital, swing bed facility, nursing facility, or other provider-operated living arrangement receiving prior approval from the department.

15. "Instrumental activities of daily living" means activities requiring cognitive ability or physical ability, or both. Instrumental activities of daily living include preparing meals, shopping, managing money, housework, laundry, taking medicine, transportation, using the telephone, and mobility outside the home.

16. "Medicaid waiver program" means the federal Medicaid waiver for the aged and disabled program, as defined in subpart G of 42 CFR 441, under which the department is authorized to provide specific home and community-based services to individuals sixty-five years and older, and individuals who are disabled who are at risk of being institutionalized.

17. "Natural supports" means an informal, unpaid caregiver that provides care to an applicant or eligible individual.

18. "Pattern of absenteeism" means an agency or individual provider who has been absent three or more times without notifying the eligible individual or their legal decisionmaker or rescheduling the appointment.

19. "Sanction" means an action taken by the department against a qualified service provider for noncompliance with a federal or state law, rule, or policy, or with the provisions of the Medicaid provider agreement.

20. "Service fee" means the amount a SPED-eligible individual is required to pay toward the cost of the eligible individual's SPED services.

21. "Service payment" means the payment issued by the department to a qualified service provider for the provision of authorized home and community-based services to eligible individuals sixty-five years and older, and individuals who are disabled.

22. "SPED program" means the service payments for elderly and disabled program, a state program which authorizes the department to reimburse qualified service providers for the provision of covered home and community-based services to eligible individuals sixty-five years and older, and individuals who are disabled.

23. "SPED program pool" means the list maintained by the department which contains the names of eligible individuals for whom SPED program funding is available when the eligible individuals' names are transferred from the SPED program pool to SPED program active status.