# 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

### § 75-03-23-01. Definitions.

The terms used in this chapter have the same meaning as in North Dakota Century Code chapter
50-06.2. In addition, as used in this chapter:
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:
a. Physical health;
b. Cognitive and emotional functioning;
c. Activities of daily living;
d. Instrumental activities of daily living;
e. Informal supports;
f. Need for twenty-four-hour supervision;
g. Social participation;
h. Physical environment;
i. Financial resources;
j. Adaptive equipment;
k. Environmental modification; and
l. Other information about the individual's condition not recorded elsewhere.
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.
History: Effective June 1, 1995; amended effective January 1, 2009; October 1, 2014; January 1,
2018; January 1, 2020; July 1, 2020; January 1, 2022; January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5)
### § 75-03-23-02. Eligibility criteria.

1. An applicant must be entered in the SPED program pool before service payments may be
authorized. The department shall allow entry into the SPED program pool to occur:
a. When the department's designee submits a form in the manner prescribed by the
department; or
b. When the applicant meets the special circumstances provided in subsection 4, 5, or 6 of
section 75-03-23-03.
2. An applicant's resources may not exceed fifty thousand dollars for the applicant to be eligible
for services under the SPED program. For purposes of this section, resources are cash or
similar assets, except recovery rebates authorized by section 2201 of the federal Coronavirus
Aid, Relief, and Economic Security Act of 2020 [Pub. L. 116-136], that can be readily
converted to cash and include residences owned by the applicant other than the applicant's
primary residence.
3. An applicant eighteen years of age or older is eligible for the SPED program pool if:
a. The applicant has a functional impairment as specified by the department in policies and
procedures to indicate applicant eligibility;
b. The applicant's functional impairment has lasted, or can be expected to last, three
months or longer;

c. The applicant's functional impairment is not the result of a mental illness or a condition of
mental retardation, or a closely related condition;
d. The applicant is living in North Dakota in a housing arrangement commonly considered a
private residence and not in an institution;
e. The applicant is not eligible for services under the Medicaid waiver program or the
Medicaid state plan option of personal care services unless the applicant's estimated
monthly benefits under this chapter, excluding the cost of case management, are
between the current medically needy income level for a household of one plus the
disregard established in North Dakota Century Code section 50-24.1-02.3, and the
lowest level of the fee schedule for services under North Dakota Century Code chapter
50-06.2, or unless the individual is receiving a service that is not available under
Medicaid or the Medicaid waiver;
f. The applicant would receive one or more of the covered services under department
policies and procedures for the specific service;
g. The applicant agrees to the plan of care developed for the provision of home and
community-based services;
h. The applicant is not responsible for one hundred percent of the cost of the covered
service provided, under the SPED program sliding fee scales based on family size and
income; and
i. The applicant has not made a disqualifying transfer of assets.
4. An applicant under eighteen years of age is eligible for the SPED program pool if the applicant
is determined to need nursing facility level of care as provided for in section 75-02-02-09 and
the applicant's care need is not the result of a mental illness or the condition of mental
retardation, or a closely related condition.
5. An applicant under eighteen years of age:
a. Must meet the eligibility requirements of subsections 3 and 4.
b. Is not eligible to receive personal care services under this chapter.
c. Is not eligible for service payments unless:
(1) Care provided to the applicant by the applicant's parent or the applicant's spouse is
provided under family home care.
(2) The applicant is unable to regularly attend school or is severely limited in the
amount of time the applicant is able to attend school.
6. An applicant must be capable of directing self-care or must have a legally responsible party to
act on the applicant's behalf.
7. An applicant is not eligible for service payments if the care provided is court-ordered.
8. An applicant is eligible to receive covered services reimbursed under North Dakota Century
Code chapter 50-06.2 or this chapter even if the applicant has natural supports.
History: Effective June 1, 1995; amended effective January 1, 2009; October 1, 2014; April 1, 2016;
January 1, 2018; May 19, 2020; January 1, 2022.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5), 50-06.2-04(3)

### § 75-03-23-03. Eligibility determination - Authorization of services.

1. An individual transferred to SPED program active status from the SPED program pool shall
continue to meet the eligibility criteria of section 75-03-23-02 in order to remain eligible for
services funded under the SPED program.
2. The department is responsible for:
a. Verifying that the individual transferred to active status continues to meet the eligibility
criteria for placement into the SPED program pool;
b. Developing a care plan;
c. Authorizing covered services in accordance with department policies and procedures;
d. Verifying the financial eligibility criteria in relation to income, assets, and deductions; and
e. Assuring that other potential federal and third-party funding sources for similar services
are sought first.
3. A recipient of services under the Medicaid waiver program, who becomes ineligible for the
Medicaid waiver program because evaluation shows that the recipient no longer requires a
nursing facility level of care, does not have to go through the SPED program pool to receive
services through the SPED program provided the individual meets all eligibility criteria in
section 75-03-23-02.
4. A recipient of services under the Medicaid personal care service option, who becomes
ineligible for services under the Medicaid personal care service option, does not have to go
through the SPED program pool to receive services through the SPED program provided the
individual meets all eligibility criteria in section 75-03-23-02.
5. A recipient of services under the expanded service payments for elderly and disabled
program, who becomes ineligible for services under the expanded service payments for
elderly and disabled program, does not have to go through the SPED program pool to receive
services through the SPED program provided the individual meets all eligibility criteria in
section 75-03-23-02.
6. An individual who is discharged from an inpatient hospital stay, skilled nursing facility,
swing-bed facility, long-term care facility, or basic care facility or who has been off of the SPED
program for fewer than ninety days, does not have to go through the SPED program pool to
receive services through the SPED program provided the individual meets all eligibility criteria
in section 75-03-23-02.
History: Effective June 1, 1995; amended effective January 1, 2009; July 1, 2020; January 1, 2022;
January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5)
### § 75-03-23-04. Eligibility criteria for Medicaid waiver program.

An applicant is eligible to receive services funded by the Medicaid waiver program if:
1. The applicant is sixty-five years and older; or
2. The applicant is under age sixty-five with a congenital disability, a disability due to trauma, or a
disability that is acquired and:

a. The disability must not be the result of mental illness as the primary diagnosis or the
result of mental retardation, or a closely related condition; and
b. The disability must meet the social security administration's definition of disability or the
individual must be determined physically disabled by the state review team under section
75-02-02.1-14.
3. The applicant is receiving Medicaid;
4. The applicant is evaluated to be in need of a nursing facility level of care;
5. The applicant's needs may be met by one or more of the covered services, as determined by
an assessment conducted in accordance with department policies and procedures;
6. The applicant's service provider is not the applicant's spouse, except when allowed by an
approved waiver, or, if the applicant is less than eighteen years old, the applicant's service
provider is not the applicant's parent, stepparent, or a person legally responsible for the care
of the individual unless allowed by an approved waiver;
7. The applicant agrees to accept services provided under the Medicaid waiver program instead
of nursing home care; and
8. The applicant agrees to the plan of care developed for the provision of home and
community-based services.
History: Effective June 1, 1995; amended effective January 1, 2009; January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5), 50-06.2-03(6)
### § 75-03-23-05. Services covered under the SPED program - Programmatic criteria.

The department may not include room and board costs in the SPED service payment. The
following categories of services are covered under the SPED program and may be provided to an
eligible individual:
1. The department may provide adult day care services to an eligible individual:
a. Who requires assistance in activities of daily living or instrumental activities of daily living;
b. Who is able to participate in group activities; and
c. Who, if the eligible individual does not live alone, has a primary caregiver who will benefit
from the temporary relief of care giving.
2. The department may provide adult foster care using a licensed adult foster care provider to an
eligible individual eighteen years of age or older:
a. Who resides in a licensed adult foster care home;
b. Who requires care or supervision;
c. Who would benefit from a family or shared living environment; and
d. Whose required care does not exceed the capability of the foster care provider.
3. The department may provide chore services to an eligible individual for one-time, intermittent,
or occasional activities which would enable the eligible individual to remain in the home.
Activities such as heavy housework and periodic cleaning, professional extermination, snow
removal, and emergency response systems may be provided. Eligible individuals receiving

emergency response services must be cognitively and physically capable of activating the
emergency response system. The activity must be the responsibility of the eligible individual
and not the responsibility of the landlord.
4. The department may provide environmental modification to an eligible individual:
a. Who owns or rents the home to be modified. If the home is rented the property owner
shall approve the modification consistent with the property owner's obligations pursuant
to section 804(f)(3)(A) of the Fair Housing Act [42 U.S.C. 3604(f)(3)(A)] before the
installation of the environmental modification; and
b. When the modification will enable the eligible individual to complete the eligible
individual's own personal care or to receive care and allow the eligible individual to safely
stay in the home.
5. a. The department may provide extended personal care services to an eligible individual
who:
(1) Requires skilled or nursing care that requires training by a nurse licensed under
North Dakota Century Code chapter 43-12.1; and
(2) Has a cognitive or physical impairment that prevents the eligible individual from
completing the required activity.
b. Extended personal care services do not include assistance with activities of daily living or
instrumental activities of daily living.
6. The department may provide family home care services to an eligible individual who:
a. Lives in the same residence as the care provider on a twenty-four-hour basis;
b. Agrees to the provision of services by the care provider; and
c. Is the spouse of the care provider or the current or former spouse of one of the following
relatives of the eligible individual: parent, grandparent, adult child, adult sibling, adult
grandchild, adult niece, or adult nephew.
7. The department may provide home and community-based services case management
services to an eligible individual who needs a functional assessment and the coordination of
cost-effective delivery issues. A social worker licensed under North Dakota Century Code
chapter 43-41 or a registered nurse licensed under North Dakota Century Code chapter
43-12.1 may provide the case management services.
8. The department may provide home-delivered meals to an eligible individual who lives alone
and is unable to prepare an adequate meal for themselves, or who lives with an individual who
is unable or not available to prepare an adequate meal for the eligible individual.
9. The department may provide homemaker services to an eligible individual who needs
assistance with environmental maintenance activities including light housekeeping, laundry,
meal planning and preparation, and shopping on an intermittent or occasional basis. The
department may pay a provider for laundry, shopping, meal preparation, money management,
or communication, if the activity benefits the eligible individual. The department may pay a
provider for housekeeping activities involving the eligible individual's personal private space
and if the eligible individual is living with an adult, the eligible individual's share of common
living space. The homemaker services funding cap applies to a household and may not be
exceeded regardless of the number of eligible individuals residing in that household.

10. The department may provide nonmedical transportation services to eligible individuals who
are unable to provide their own transportation and need transportation to access essential
community services such as grocery stores or pharmacies. "Nonmedical transportation
services" are transportation services not related to the receipt of medical care.
11. The department may provide personal care services to an eligible individual who needs help
or supervision with personal care activities if:
a. The eligible individual is at least eighteen years of age; and
b. The services are provided in the eligible individual's home or in a provider's home if the
provider meets the definition of a relative as defined in subdivision c of subsection 6 of
section 75-03-23-05.
12. a. The department may provide respite care services to an eligible individual in the eligible
individual's home, in the provider's home, in a nursing home, in a swing-bed facility, in a
basic care facility, or in a hospital, if:
(1) The eligible individual has a full-time primary caregiver;
(2) The eligible individual needs a qualified caregiver or it would be inappropriate to use
an unqualified caregiver in the absence of the primary caregiver;
(3) The primary caregiver's need for the relief is intermittent or occasional; and
(4) The primary caregiver's need for relief is not due to the primary caregiver's
employment or attendance at school as a part-time or full-time student.
b. An eligible individual who is a resident of an adult foster care may choose a respite
provider and is not required to use a relative of the adult foster care provider as the
eligible individual's respite provider.
13. The department may provide companionship services up to ten hours per month to eligible
individuals who live alone and could benefit from services to help reduce social isolation.
14. The department may provide other services as the department determines appropriate.
History: Effective June 1, 1995; amended effective January 1, 2009; October 1, 2014; April 1, 2016;
January 1, 2020; January 1, 2022; January 1, 2024; January 1, 2025.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5)
### § 75-03-23-06. Services covered under the Medicaid waiver program - Programmatic criteria.

The department may not include room and board costs in the Medicaid waiver service payment.
The following services are covered under the Medicaid waiver program and may be provided to an
eligible individual:
1. The department may provide adult day care services to an eligible individual:
a. Who requires assistance in activities of daily living or instrumental activities of daily living;
b. Who is able to participate in group activities; and
c. If the eligible individual does not live alone, whose primary caregiver will benefit from the
temporary relief of care giving.

2. The department may provide adult foster care, using a licensed adult foster care provider, to
an eligible individual who resides in a licensed adult foster care home who:
a. Is eighteen years of age or older;
b. Requires care or supervision;
c. Would benefit from a family or shared living environment; and
d. Requires care that does not exceed the capability of the foster care provider.
3. The department may provide residential care to an eligible individual who:
a. Has chronic moderate to severe memory loss; or
b. Has a significant emotional, behavioral, or cognitive impairment.
4. The department may provide chore services to an eligible individual for one-time, intermittent,
or occasional activities that would enable the eligible individual to remain in the home, such as
heavy housework and periodic cleaning, professional extermination, and snow removal. The
activity must be the responsibility of the eligible individual and not the responsibility of the
landlord.
5. The department may provide an emergency response system to an eligible individual who
lives alone or with an adult who is incapacitated, or who lives with an individual whose routine
absences from the home present a safety risk for the eligible individual, and the eligible
individual is cognitively and physically capable of activating the emergency response system.
6. The department may provide environmental modification to an eligible individual, if the eligible
individual owns or rents the home to be modified and if the modification will enable the eligible
individual to complete the eligible individual's own personal care or to receive care and will
allow the eligible individual to safely stay in the home for a period of time that is long enough
to offset the cost of the modification. If the home is rented the property owner shall approve
the modification consistent with the property owner's obligations pursuant to section 804(f)(3)
(A) of the Fair Housing Act [42 U.S.C. 3604(f)(3)(A)] before the installation of the
environmental modification.
7. a. The department may provide family personal care to an eligible individual who:
(1) Lives in the same residence as the care provider on a twenty-four-hour basis;
(2) Agrees to the provision of services by the care provider; and
(3) Is the legal spouse of the care provider or is a relative identified within the definition
of "family home care" under subsection 4 of North Dakota Century Code section
50-06.2-02.
b. The department may not provide a family personal care payment for assistance with the:
(1) Activities of communication, community integration, laundry, meal preparation,
money management, shopping, social appropriateness, or transportation unless the
activity benefits the eligible individual; or
(2) Activity of housework unless the activity is for the eligible individual's personal
space or if the eligible individual is living with an adult, the eligible individual's share
of common living space.

8. The department may provide home and community-based services case management
services to an eligible individual who needs a comprehensive assessment or care coordination
to ensure cost-effective delivery of services. A social worker licensed under North Dakota
Century Code chapter 43-41, a registered nurse licensed under North Dakota Century Code
chapter 43-12.1, or another approved provider with substantially similar credentials as defined
in the Medicaid waiver program may provide case management services under this
subsection.
9. The department may provide home-delivered meals to an eligible individual who lives alone
and is unable to prepare an adequate meal for themselves or who lives with an individual who
is unable or not available to prepare an adequate meal.
10. The department may provide homemaker services to an eligible individual who needs
assistance with environmental maintenance activities, including light housekeeping, laundry,
meal planning and preparation, and shopping on an intermittent or occasional basis. The
department may pay a provider for laundry, shopping, meal preparation, money management,
or communication, if the activity benefits the eligible individual. The department may pay a
provider for housekeeping activities involving the eligible individual's personal private space
and if the eligible individual is living with an adult, the eligible individual's share of common
living space. The homemaker service funding cap applies to a household and may not be
exceeded regardless of the number of eligible individuals residing in that household.
11. a. The department may provide extended personal care services to an eligible individual
who:
(1) Requires skilled or nursing care that requires training by a nurse licensed under
North Dakota Century Code chapter 43-12.1; and
(2) Has a cognitive or physical impairment that prevents the eligible individual from
completing the required activity.
b. Extended personal care services do not include assistance with activities of daily living
and instrumental activities of daily living.
12. The department may provide nonmedical transportation services to an eligible individual who
is unable to provide their own transportation and who needs transportation to access essential
community services such as grocery stores or pharmacies. "Nonmedical transportation
services" are transportation services not related to the receipt of medical care.
13. The department may provide up to twenty-four hours per day of supervision to an eligible
individual who has a cognitive or physical impairment that results in the eligible individual
needing monitoring to assure the eligible individual's continued health and safety. The
department may not approve supervision services to be provided by a provider who lives in
the same home as the eligible individual.
14. a. The department may provide respite care services to an eligible individual in the eligible
individual's home, in the provider's home, in a nursing home, in a swing-bed facility, in a
basic care facility, or in a hospital, if:
(1) The eligible individual has a full-time primary caregiver;
(2) The eligible individual needs a qualified caregiver or it would be inappropriate to use
an unqualified caregiver in the absence of the primary caregiver;
(3) The primary caregiver's need for the relief is intermittent or occasional; and

(4) The primary caregiver's need for relief is not due to the primary caregiver's
employment or attendance at school as a part-time or full-time student.
b. An eligible individual who is a resident of an adult foster care home may choose a respite
provider and is not required to use a relative of the adult foster care provider as the
eligible individual's respite provider.
15. The department may provide specialized equipment and supplies to an eligible individual, if:
a. The eligible individual's need for the items is based on an adaptive assessment;
b. The items directly benefit the eligible individual's ability to perform personal care or
household activities;
c. The items will reduce the intensity or frequency of human assistance required to meet
the eligible individual care needs;
d. The items are necessary to prevent the eligible individual's institutionalization;
e. The items are not available under the Medicaid state plan; and
f. The eligible individual is motivated to use the item.
16. The department may provide supported employment to an eligible individual who is unlikely to
obtain competitive employment at or above the minimum wage; who, because of the eligible
individual's disabilities, needs intensive ongoing support to perform in a work setting; and who
has successfully completed the supported employment program available through the North
Dakota vocational rehabilitation program.
17. The department may provide transitional living services to an eligible individual who needs
supervision, training, or assistance with self-care, communication skills, socialization, sensory
and motor development, reduction or elimination of maladaptive behavior, community living,
and mobility. The department may provide these services until the eligible individual's
independent living skills development has been met or until an interdisciplinary team
determines the service is no longer appropriate for the eligible individual.
18. The department may provide community transition services to an eligible individual who is
transitioning from an institution or another provider-operated living arrangement to a living
arrangement in a private residence where the eligible individual is directly responsible for their
own living expenses and needs nonrecurring set-up expenses. Community transition services
include one-time transition costs and transition coordination.
a. Allowable expenses are those necessary to enable an eligible individual to establish a
basic household that do not constitute room and board and may include:
(1) Security deposits that are required to obtain a lease on a private residence;
(2) Essential household furnishings required to occupy and use a private residence,
including furniture, window coverings, food preparation items, and bed and bath
linens;
(3) Setup fees or deposits for utility or service access, including telephone, electricity,
heating, and water;
(4) Services necessary for the eligible individual's health and safety, such as pest
eradication and one-time cleaning prior to occupancy;
(5) Moving expenses;

(6) Necessary home accessibility adaptations; and
(7) Activities to assess need and to arrange for and procure need resources.
b. Community transition services do not include monthly rental or mortgage expenses,
escrow, specials, insurance, food, regular utility or service access charges, household
appliances, or items that are intended for purely diversional or recreational purposes.
c. Community transition services are furnished only to the extent that they are reasonable
and necessary as determining through the service plan development process, clearly
identified in the service plan and the eligible individual is unable to meet such expense,
or when the services cannot be obtained from other sources.
19. The department may provide other services as permitted by an approved waiver.
20. The department may provide residential habilitation up to twenty-four hours per day to an
eligible individual who needs formalized training and supports and requires some level of
ongoing daily support. This service is designed to assist with and develop self-help,
socialization, and adaptive skills that improve the eligible individual's ability to independently
reside and participate in an integrated community. Residential habilitation may be provided in
an agency foster home for adults facility or in a private residence owned or leased by an
eligible individual or their family member.
21. The department may provide community support services up to twenty-four hours per day to
an eligible individual who requires some level of ongoing daily support. This service is
designed to assist with self-care tasks and socialization that improves the eligible individual's
ability to independently reside and participate in an integrated community. Community support
services may be provided in an agency foster home for adults facility or in a private residence
owned or leased by an eligible individual or their family member.
22. The department may provide companionship services up to ten hours per month to eligible
individuals who live alone and could benefit from services to help reduce social isolation.
23. The department may provide personal care services to an eligible individual who needs
supervision and help with personal care services, subject to the following limitations:
a. Eligible individuals for family personal care services are not eligible to receive personal
care services under the Medicaid waiver program from a provider who lives in the same
home as the eligible individual;
b. The department may not pay for personal care services under the Medicaid waiver
program to a provider who lives in the same home as the eligible individual if the provider
meets the definition of family member in North Dakota Century Code section 50-06.2-02;
and
c. Live-in personal care service is capped at ten hours per day.
History: Effective June 1, 1995; amended effective January 1, 2009; October 1, 2014; April 1, 2016;
January 1, 2018; January 1, 2020; January 1, 2022; January 1, 2024; January 1, 2025; January 1,
2026.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5)
### § 75-03-23-07. Qualified service provider standards and agreements.

1. An individual or agency seeking designation as a qualified service provider shall complete and
submit the applicable forms supplied by the department in the form and manner prescribed.

The qualified service provider, including any employees of an agency designated as a
qualified service provider, shall meet all licensure, certification, or competency requirements
applicable under state or federal law and departmental standards necessary to provide care to
eligible individuals whose care is paid by public funds. An application is not complete until the
individual or agency submits all required information and required provider verifications to the
department.
2. A provider or an individual seeking designation as a qualified service provider:
a. Must have the basic ability to read, write, and verbally communicate;
b. Must not be an individual who has been found guilty of, pled guilty to, or pled no contest
to:
(1) An offense described in North Dakota Century Code chapter 12.1-16, homicide;
12.1-18, kidnapping; 12.1-27.2, sexual performances by children; or 12.1-41, Uniform
Act on Prevention of and Remedies for Human Trafficking; or North Dakota Century
Code section 12.1-17-01, simple assault, if a class C felony under subdivision a of
subsection 2 of that section; 12.1-17-01.1, assault; 12.1-17-01.2, domestic violence;
12.1-17-02, aggravated assault; 12.1-17-03, reckless endangerment; 12.1-17-04,
terrorizing; 12.1-17-06, criminal coercion; 12.1-17-07.1, stalking; 12.1-17-12, assault
or homicide while fleeing peace officer; 12.1-20-03, gross sexual imposition;
12.1-20-03.1, continuous sexual abuse of a child; 12.1-20-04, sexual imposition;
12.1-20-05, corruption or solicitation of minors; 12.1-20-05.1, luring minors by
computer or other electronic means; 12.1-20-06, sexual abuse of wards;
12.1-20-06.1, sexual exploitation by therapist; 12.1-20-07, sexual assault;
12.1-20-12.3, sexual extortion; 12.1-21-01, arson; 12.1-22-01, robbery; or
12.1-22-02, burglary, if a class B felony under subdivision b of subsection 2 of that
section; 12.1-29-01, promoting prostitution; 12.1-29-02, facilitating prostitution;
12.1-31-05, child procurement; 12.1-31-07, endangering a vulnerable adult;
12.1-31-07.1, exploitation of a vulnerable adult; 14-09-22, abuse of a child;
14-09-22.1, neglect of a child; subsection 1 of section 26.1-02.1-02.1, fraudulent
insurance acts; or an offense under the laws of another jurisdiction which requires
proof of substantially similar elements as required for conviction under any of the
enumerated North Dakota statutes; or
(2) An offense, other than a direct-bearing offense identified in paragraph 1 of
subdivision b of subsection 2, if the department determines that the individual has
not been sufficiently rehabilitated.
(a) The department may not consider a claim that the individual has been
sufficiently rehabilitated until any term of probation, parole, or other form of
community corrections or imprisonment has elapsed, unless sufficient
evidence is provided of rehabilitation.
(b) An individual's completion of a period of three years after final discharge or
release from any term of probation, parole, or other form of community
corrections or imprisonment, without subsequent charge or conviction, is
prima facie evidence of sufficient rehabilitation;
c. In the case of an offense described in North Dakota Century Code section 12.1-17-01,
simple assault, if a felony; 12.1-17-01.1, assault; 12.1-17-01.2, domestic violence, if a
misdemeanor; 12.1-17-03, reckless endangerment; 12.1-17-04, terrorizing; 12.1-17-06,
criminal coercion; 12.1-17-07.1, stalking; 12.1-18-03, unlawful imprisonment; 12.1-20-05,
corruption or solicitation of minors, if a misdemeanor; 12.1-20-07, sexual assault, if a
misdemeanor; or equivalent conduct in another jurisdiction which requires proof of

substantially similar elements as required for conviction, the department may determine
that the individual has been sufficiently rehabilitated if five years have elapsed after final
discharge or release from any term of probation, parole, or other form of community
corrections or imprisonment;
d. Shall maintain confidentiality;
e. Shall, using applicable forms and providing documentation as required by the
department:
(1) Revalidate qualified service provider enrollment except as provided in paragraph 3,
within the time period as required by the Medicaid state plan option for personal
care services or Medicaid waiver program, whichever occurs first; and
(2) Provide evidence of competency, except as provided in paragraph 3, at least every
sixty months for an agency enrolled as a qualified service provider or at least every
thirty months for an individual enrolled as a qualified service provider, and within the
time period as required by the Medicaid state plan option for personal care services
or Medicaid waiver program, whichever occurs first; or
(3) Revalidate qualified service provider enrollment only every sixty months for an
individual enrolled as a qualified service provider providing family home care
services under the SPED program and expanded service payments for elderly and
disabled;
f. Must be physically capable of performing the service for which they were contracted with
or hired as an independent contractor; and
g. Must be at least eighteen years of age.
h. A representative of an enrolled qualified service provider agency or an individual qualified
service provider shall complete a department-approved qualified service provider
orientation prior to initial enrollment.
3. If the physical, cognitive, social, or emotional health capabilities of an applicant or provider
appear to be questionable, the department may require the applicant or provider to present
evidence of the applicant's or provider's ability to provide the required care based on a formal
evaluation. The department is not responsible for costs of any required evaluation.
4. The offenses enumerated in paragraph 1 of subdivision b of subsection 2 have a direct
bearing on an individual's ability to be enrolled as a qualified service provider.
a. An individual enrolled as a qualified service provider prior to January 1, 2009, who has
been found guilty of, pled guilty to, or pled no contest to, an offense considered to have a
direct bearing on the individual's ability to provide care may be considered rehabilitated
and may continue to provide services if the individual has had no other offenses and
provides sufficient evidence of rehabilitation to the department.
b. The department may not approve, deny, or renew an application for an individual or
employee of an agency who is applying to enroll or re-enroll as a qualified service
provider and who has been charged with an offense considered to have a direct bearing
on the individual's ability to provide care or an offense in which the alleged victim was
under the applicant's care, until final disposition of the criminal case against the
individual.

5. Evidence of competency for adult foster care providers serving eligible individuals eligible for
the developmental disability waiver must be provided in accordance with subdivision b of
subsection 2 of section 75-03-21-08.
6. A provider of services for adult day care, adult foster care, community support services,
extended personal care, family personal care, nurse assessment, personal care, residential
care, respite care, residential habilitation, supervision, and transitional living care shall provide
evidence of competency in generally accepted procedures for:
a. Infection control and proper handwashing methods;
b. Handling and disposing of body fluids;
c. Tub, shower, and bed bathing techniques;
d. Hair care techniques, sink shampoo, and shaving;
e. Oral hygiene techniques of brushing teeth and cleaning dentures;
f. Caring for an eligible individual who is incontinent;
g. Feeding or assisting an eligible individual with eating;
h. Basic meal planning and preparation;
i. Assisting an eligible individual with the self-administration of medications;
j. Maintaining a kitchen, bathroom, and other rooms used by an eligible individual in a
clean and safe condition, including dusting, vacuuming, floor care, garbage removal,
changing linens, and other similar tasks;
k. Laundry techniques, including mending, washing, drying, folding, putting away, ironing,
and related work;
l. Assisting an eligible individual with bill paying and balancing a check book;
m. Dressing and undressing an eligible individual;
n. Assisting with toileting;
o. Routine eye care;
p. Proper care of fingernails;
q. Caring for skin;
r. Turning and positioning an eligible individual in bed;
s. Transfer using a belt, standard sit, or bed to wheelchair;
t. Assisting an eligible individual with ambulation; and
u. Making wrinkle-free beds.
7. An applicant for qualified service provider status for adult foster care, extended personal care,
family personal care, nurse assessment, personal care, residential care, supervision,
transitional living care, respite care, or adult day care shall secure written verification that the
applicant is competent to perform procedures specified in subsection 5 from a physician,
chiropractor, registered nurse, licensed practical nurse, occupational therapist, physical

therapist, or an individual with a professional degree in specialized areas of health care.
Written verification of competency is not required if the individual holds one of the following
licenses or certifications in good standing: physician, physician assistant, chiropractor,
registered nurse, licensed practical nurse, registered physical therapist, registered
occupational therapist, or certified nurse assistant. A certificate or another form of
acknowledgment of completion of a program with a curriculum that includes the competencies
in subsection 5 may be considered evidence of competence.
8. The department may approve global and eligible individual-specific endorsements to provide
particular procedures for a provider based on written verification of competence to perform the
procedure from a physician, chiropractor, registered nurse, occupational therapist, physical
therapist, or other individual with a professional degree in a specialized area of health care or
approved within the scope of the individual's health care license or certification.
9. Competence may be demonstrated in the following ways:
a. A demonstration of the procedure being performed;
b. A detailed verbal explanation of the procedure; or
c. A detailed written explanation of the procedure.
10. The department shall notify the individual or the agency of its decision on designation as a
qualified service provider.
11. The department shall maintain a list of qualified service providers. Once the eligible
individual's need for services has been determined, the eligible individual selects a provider
from the list and the department's designee issues an authorization to provide services to the
selected qualified service provider.
12. The department may issue a service payment to a qualified service provider that bills the
department after the delivery of authorized services.
13. Agency providers who employ nonfamily members shall have a department-approved quality
improvement program that includes a process to identify, address, and mitigate harm to the
eligible individuals they serve.
14. Agency providers who have accepted an authorization to provide twenty-four-hour supports to
an eligible individual shall give a thirty-day written notice before they can involuntarily
discharge the eligible individual from their care, unless otherwise approved by the department.
History: Effective June 1, 1995; amended effective March 1, 1997; January 1, 2009; October 1, 2014;
April 1, 2016; January 1, 2018; January 1, 2020; January 1, 2022; October 1, 2022; January 1, 2024;
January 1, 2025.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)
### § 75-03-23-08. Denial of application to become a qualified service provider.

The department may deny an application to become a qualified service provider if:
1. The applicant voluntarily withdraws the application;
2. The applicant is not in compliance with applicable state laws, state regulations, or program
issuances governing providers;
3. The applicant, if previously enrolled as a qualified service provider, was not in compliance with
the terms set forth in the application or provider agreement;

4. The applicant, if previously enrolled as a qualified service provider, was not in compliance with
the provider certification terms on the claims submitted for payment;
5. The applicant, if previously enrolled as a qualified service provider, had assigned or otherwise
transferred the right to payment of a program claim, except as provided in 42 U.S.C. 1396a(a)
(32);
6. The applicant, if previously enrolled as a qualified service provider, had demonstrated a
pattern of submitting inaccurate billings or cost reports;
7. The applicant, if previously enrolled as a qualified service provider, had demonstrated a
pattern of submitting billings for services not covered under department programs;
8. 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;
9. The applicant has delivered goods, supplies, or services that are of an inferior quality or are
harmful to individuals;
10. The applicant has been convicted of an offense determined by the department to have a direct
bearing upon the applicant's ability to be enrolled as a qualified service provider, or the
department determines, following conviction of any other offense, the applicant is not
sufficiently rehabilitated;
11. The applicant, if previously enrolled as a qualified service provider, owes the department
money for payments incorrectly made to the provider;
12. The qualified service provider is currently excluded from participation in Medicare, Medicaid,
or any other federal health care program;
13. The applicant has not provided sufficient evidence to the department, after obtaining a formal
evaluation under subsection 3 of section 75-03-23-07, that the applicant is physically,
cognitively, socially, or emotionally capable of providing the care;
14. The applicant previously has been terminated for inactivity and does not have a prospective
public pay-eligible individual;
15. The applicant previously has been terminated for inactivity and has not provided valid reason
for the inactivity; or
16. For other good cause.
History: Effective June 1, 1995; amended effective January 1, 2009; October 1, 2014; April 1, 2016;
January 1, 2020; January 1, 2022; October 1, 2022; January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)
### § 75-03-23-08.1. Sanctions and termination of qualified service providers.

1. The department may impose sanctions against a qualified service provider for any of the
reasons listed under section 75-02-05-05 or subdivisions b though g of subsection 4. Prior to
imposing sanctions, the department may require provider education or a business integrity
agreement.
2. The department may consider the following in determining the sanction to be imposed:
a. Seriousness of the qualified service provider's offense.

b. Extent of the qualified service provider's violations.
c. Qualified service provider's history of prior violations.
d. Prior imposition of sanctions against the qualified service provider.
e. Prior provision of information and training to the qualified service provider.
f. Qualified service provider's agreement to make restitution to the department.
g. Actions taken or recommended by peer groups or licensing boards.
h. Access to care for eligible individuals.
i. Qualified service provider's self-disclosure or self-audit discoveries.
j. Qualified service provider's willingness to enter a business integrity agreement.
3. The department may impose any of the sanctions listed in subsections 8 or 9 of section
75-02-05-07.
4. The department may terminate a qualified service provider if:
a. The qualified service provider voluntarily withdraws from participation as a qualified
service provider.
b. The qualified service provider is not in compliance with applicable state laws, state
regulations, or program issuances governing providers.
c. The qualified service provider is not in compliance with the terms set forth in the
application or provider agreement.
d. The qualified service provider is not in compliance with the provider certification terms on
the claims submitted for payment.
e. The qualified service provider has assigned or otherwise transferred the right to payment
of a program claim, except as provided in 42 U.S.C. 1396a(a)(32).
f. The qualified service provider has demonstrated a pattern of submitting inaccurate
billings or cost reports.
g. The qualified service provider has demonstrated a pattern of submitting billings for
services not covered under department programs.
h. The qualified service provider has been debarred or the provider's license or certificate to
practice in the provider's profession or to conduct business has been suspended or
terminated.
i. The qualified service provider has delivered goods, supplies, or services that are of an
inferior quality or are harmful to individuals.
j. The qualified service provider has been convicted of an offense determined by the
department to have a direct bearing upon the provider's ability to be enrolled as a
qualified service provider, or the department determines, following conviction of any other
offense, the provider is not sufficiently rehabilitated.
k. The qualified service provider is currently excluded from participation in Medicare,
Medicaid, or any other federal health care program.

l. The qualified service provider has not provided sufficient evidence to the department,
after obtaining a formal evaluation under subsection 3 of section 75-03-23-07 that the
provider is physically, cognitively, socially, or emotionally capable of providing the care.
m. The qualified service provider refuses to repay or make arrangements for the repayment
of identified overpayments or otherwise erroneous payments.
n. There has been no billing activity within the twelve months since the qualified service
provider's enrollment or most recent re-enrollment date.
o. The qualified service provider has demonstrated a pattern of absenteeism by failing to
provide care they have been authorized and agreed to provide per subsection 11 of
section 75-03-23-07 to an eligible individual.
p. For other good cause.
History: Effective January 1, 2020; amended effective January 1, 2022; October 1, 2022; January 1,
2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)
### § 75-03-23-09. Payment under the SPED program and the Medicaid waiver program.

1. The department shall establish provider rates for home and community-based service in
accordance with a procedure that factors in:
a. Whether a provider is an individual or an agency; and
b. The range of rates submitted by various providers.
2. The rate for a specific qualified service provider is established at the time the provider
agreement is signed.
3. The department shall grant a request for a rate decrease when the department receives a
written request for the decrease from the qualified service provider.
4. The department shall grant in full or in part, or shall deny, a request for a rate increase when
the department receives a written request for the rate increase from the qualified service
provider.
5. The department shall determine the maximum amount allowable per eligible individual each
month for a specific service.
6. The department shall establish the aggregate maximum amount allowable per eligible
individual each month for all services. The aggregate maximum amount per eligible individual
depends on whether the eligible individual is receiving services under the SPED program,
under the Medicaid waiver program, or under both programs.
7. The department or designee may grant approval to exceed the monthly service program
maximum for a specific eligible individual who is only receiving SPED funds and no Medicaid
funds if the eligible individual has a special or unique circumstance; the SPED-eligible
individual is not eligible for Medicaid; and the need for additional service program funds will
not initially exceed three months. Under emergency conditions, the department may grant a
one-time extension not to exceed an additional three months.
8. The department may grant approval to exceed the monthly service program maximum for a
specific eligible individual who is receiving SPED funds and Medicaid funds or only Medicaid
funds if the eligible individual has a special or unique circumstance; and the need for

additional service program funds does not exceed three months. Under emergency
conditions, the department may grant a one-time extension not to exceed an additional three
months.
9. The department's designee shall notify the eligible individual of the department's determination
regarding the request to exceed the monthly service program maximum. If the department
denies the request to exceed the monthly aggregate maximum, the department's designee
shall inform the eligible individual in writing of the reason for the denial, the eligible individual's
right to appeal, and the appeal process, as provided in chapter 75-01-03.
10. The department will grant approval to exceed the monthly program maximum or service
maximum for eligible individuals receiving SPED funds or Medicaid funds, or both, whose
service units exceed the program caps as a result of the qualified service provider rate
increase. This extension is limited to eligible individuals who were receiving services prior to
July 1, 2007.
11. Upon written application and good cause shown to the satisfaction of the department, the
department may grant a variance to the three months extension and one-time extension
limitation in subsections 7 and 8 upon such terms as the department may prescribe, except no
variance may permit or authorize a danger to the health or safety of a client and no variance
may be granted except at the discretion of the department. A refusal to grant a variance is not
subject to appeal.
History: Effective June 1, 1995; amended effective September 27, 2007; January 1, 2009; October 1,
2022; January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)
### § 75-03-23-10. Department to recover funds upon establishment of noncompliance.

A qualified service provider shall not submit a claim for payment or receive service payments for
services that have not been delivered in accord with department policies and procedures. The
department shall recover all payments received by a qualified service provider who fails to deliver the
services in accord with the provider agreement or department policy and procedure.
History: Effective June 1, 1995.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5), 50-06.2-03(6)
### § 75-03-23-11. Denial, reduction, and termination of services - Appeal.

1. The department or its designee shall inform an individual who is determined to be ineligible for
covered services or who becomes ineligible while receiving services in writing of the denial,
termination, or reduction, the reasons for the denial, termination, or reduction, the right to
appeal, and the appeal process as provided in chapter 75-01-03.
2. An eligible individual must receive ten calendar days' written notice before termination of
services occurs. The ten-day notice is not required if:
a. The eligible individual enters a basic care facility or a nursing facility;
b. The termination is due to changes in federal or state law;
c. The eligible individual requests termination of services; or
d. The eligible individual moves from the service area.

3. An applicant denied services or an eligible individual terminated from services should be given
an appropriate referral to other public or private service providers and should be assisted in
finding other resources.
4. The department shall deny or terminate SPED program and Medicaid waiver program
services when service to the eligible individual presents an immediate threat to the health or
safety of the eligible individual, the provider of services, or others or when services that are
available are not adequate to prevent a threat to the health or safety of the eligible individual,
the provider of services, or others. Examples of health and safety threats include physical
abuse of the provider by the eligible individual, eligible individual self-neglect, an unsafe living
environment for the eligible individual, or contraindicated practices, like smoking while using
oxygen.
History: Effective June 1, 1995; amended effective January 1, 2009; July 1, 2020; January 1, 2024.
General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5), 50-06.2-03(6), 50-06.2-04(1), 50-06.2-04(3)
### § 75-03-23-12. Provider - Request for review.

A qualified service provider may request a review of denial of payment in accordance with North
Dakota Century Code section 50-24.1-24.
History: Effective January 1, 2009; amended effective January 1, 2020.
General Authority: NDCC 50-06.2-03, 50-24.1-24
Law Implemented: NDCC 50-06.2-03, 50-24.1-24
### § 75-03-23-13. Provider - Appeals.

An applicant or provider may appeal a decision to deny or revoke a qualified service provider
enrollment by filing a written appeal with the department within ten days of receipt of written notice of
the denial or revocation. Upon receipt of a timely appeal, an administrative hearing may be conducted
in the manner provided in chapter 75-01-03. A provider or applicant who receives notice of termination
or denial of the individual's qualified service provider status 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 terminate or deny qualified service provider status.
History: Effective January 1, 2009.
General Authority: NDCC 50-06.2-03
Law Implemented: NDCC 50-06.2-03
### § 75-03-23-14. Disqualifying transfers.

1. An individual is not eligible for SPED benefits under this chapter if the department determines
that the individual or the spouse of the individual has made any assignment or transfer of any
asset for the purpose of making the individual eligible for benefits before or after making
application for SPED services except as provided in subsection 2.
2. An individual is not ineligible for SPED benefits under this chapter by reason of subsection 1
to the extent that:
a. The value of the transferred assets when added to the value of the individual's other
assets would not otherwise make the individual ineligible for SPED or does not decrease
the individual's service fee.
b. The asset transferred was a home, and title to the home was transferred to:
(1) The individual's spouse; or

(2) The individual's son or daughter who is under the age of twenty-one or who is blind
or disabled.
c. The assets:
(1) Were transferred to the individual's spouse or to another person for the sole benefit
of the individual's spouse; or
(2) Were transferred from the individual's spouse to another person for the sole benefit
of the individual's spouse.
d. The individual makes a satisfactory showing that:
(1) The individual intended to dispose of the assets at fair market value or for other
valuable consideration, and the individual had an objectively reasonable belief that
fair market value or its equivalent was received;
(2) The assets were transferred exclusively for a purpose other than to qualify for SPED
benefits under this chapter; or
(3) All assets transferred for less than fair market value have been returned to the
individual.
e. If a disqualifying transfer occurred five years prior to the date an individual initially applies
for SPED services, the department will presume that the transfer was not for the purpose
of obtaining SPED benefits.
3. There is a presumption that a transfer was made for purposes of making an individual eligible
for SPED services under this chapter:
a. If an inquiry about SPED benefits or benefits under this chapter was made, by or on
behalf of the individual to any other individual, before the date of transfer;
b. If the individual or the individual's spouse was an applicant for or an eligible individual of
SPED benefits under this chapter before the date of transfer;
c. If a transfer is made by or on behalf of the individual's spouse, if the value of the
transferred asset, when added to the value of the individual's other assets, would exceed
SPED asset limits; or
d. If the transfer was made, on behalf of the individual or the individual's spouse, by a
guardian, conservator, or attorney-in-fact, to the guardian, conservator, or attorney-in-fact
or to any spouse, child, grandchild, brother, sister, niece, nephew, parent, or grandparent,
by birth, adoption, or marriage, of the guardian, conservator, or attorney-in-fact.
4. An applicant or eligible individual who claims that assets were transferred exclusively for a
purpose other than to qualify for SPED benefits under this chapter must show a desire to
receive SPED benefits under this chapter played no part in the decision to make the transfer
and must rebut any presumption arising under subsection 3.
5. If the transferee of any assets is the child, grandchild, brother, sister, niece, nephew, parent,
grandparent, stepparent, stepchild, son-in-law, daughter-in-law, or grandchild-in-law of the
individual or the individual's spouse, services or assistance furnished by the transferee to the
individual or the individual's spouse may not be treated as consideration for the transferred
asset unless the transfer is made pursuant to a valid written contract entered into prior to
rendering the services.

6. A transfer is complete when the individual, or the individual's spouse, making the transfer has
no lawful means of undoing the transfer or requiring a restoration of ownership.
7. For purposes of this section, fair market value is received:
a. When one hundred percent of apparent fair market value is received for an asset whose
value is not subject to reasonable dispute, such as cash, bank deposits, stocks, and
fungible commodities;
b. When seventy-five percent of estimated fair market value is received for an asset whose
value may be subject to reasonable dispute; and
c. When one hundred percent of fair market value is received for an asset considered to be
income to the individual or individual's spouse.
8. If an applicant or eligible individual is denied Medicaid based on a disqualifying transfer of
assets, the SPED applicant or eligible individual is also ineligible for SPED-funded services.
History: Effective January 1, 2009; amended effective January 1, 2024.
General Authority: NDCC 50-06.2-07
Law Implemented: NDCC 50-06.2-07
### § 75-03-23-15. Application - Applicant required to provide proof of eligibility.

1. An individual wishing to apply for benefits under this chapter must have the opportunity to do
so, without delay.
2. An application is a request made to the department or its designee by an individual seeking
services under this chapter, or by an individual properly seeking services on behalf of another
individual. "An individual properly seeking services" means an individual of sufficient maturity
and understanding to act responsibly on behalf of the individual for whom services are sought.
3. An application must include a functional assessment.
4. The individual seeking services under this chapter, or an individual properly seeking services
on behalf of that individual, shall sign the application.
5. The department or its designee shall provide information concerning eligibility requirements,
available services, and the rights and responsibilities of individuals seeking services under this
chapter and of eligible individuals to all who require it.
6. The date of application is the date the department or its designee receives the properly signed
application.
7. The individual seeking services under this chapter shall provide information sufficient to
establish eligibility for benefits, including a social security number and proof of age, identity,
residence, blindness, disability, functional limitation, financial eligibility, and other information
required under this chapter.
History: Effective October 1, 2014; amended effective July 1, 2020; January 1, 2024.
General Authority: NDCC 50-06.2-03
Law Implemented: NDCC 50-06.2-03
### § 75-03-23-16. Reapplication after denial or termination.

A provider or applicant whose qualified service provider status has been terminated or denied may
not reapply if:

1. The provider's or applicant's status as a qualified service provider has been denied or revoked
within the twelve months prior to the date of the current application; except that in the case of
an individual who has been denied or terminated under subparagraph a of paragraph 2 of
subdivision b of subsection 2 of section 75-03-23-07, the individual may reapply after
completion of the term of probation; or
2. The provider's or applicant's status as a qualified service provider has been denied or revoked
three or more times and the most recent revocation or denial occurred within the three years
immediately preceding the application date.
History: Effective October 1, 2014; amended effective January 1, 2020.
General Authority: NDCC 50-06.2-03
Law Implemented: NDCC 50-06.2-03
### § 75-03-23-17. Functional assessment.

1. An initial functional assessment, using the form required by the department, must be
completed as a part of the application for benefits under this chapter. A functional assessment
must be completed at least semiannually in conjunction with the eligibility redetermination.
2. The functional assessment must include an interview with the individual in the home where the
individual resides.
History: Effective October 1, 2014.
General Authority: NDCC 50-06.2-03
Law Implemented: NDCC 50-06.2-03
