# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-11 — Substance Use Disorder Treatment Voucher System

Voucher System
Voucher System
### § 75-09.1-11-01. Definitions.

As used in this chapter, unless the context or subject matter otherwise requires:
1. "ASAM criteria" means the current edition of the criteria of the American society of addiction
medicine.
2. "Certified peer support specialist" means a human being meeting the requirements of certified
peer support specialist I or certified peer support specialist II in compliance with chapter
75-03-43.
3. "Comprehensive biopsychosocial clinical assessment" means an assessment that integrates
information regarding the biological, psychological, and social factors of an individual's life in
determining the nature of the individual's substance use disorder and criteria for treatment.
4. "Department" means the North Dakota department of health and human services.
5. "Individual" means an individual who meets the identified eligibility criteria for services under
the substance use disorder treatment voucher system.
6. "Outcomes measures" means the events or conditions that indicate the effectiveness of the
substance use disorder treatment services.
7. "Process measures" means the steps and actions taken to implement the substance use
disorder treatment services.
8. "Program" means an individual, partnership, association, corporation, or limited liability
company that establishes, conducts, or maintains a substance abuse treatment program
license in compliance with chapter 75-09.1-01 or similar license from a bordering state for the
care of individuals with a substance use disorder. "Program" does not include a DUI seminar,
which is governed by chapter 75-09.1-09 or a substance abuse treatment program operated
by a state agency.
9. "Voucher" means funding issued by the department to a licensed substance abuse treatment
program, excluding human service centers and the state hospital, for the purpose of providing
eligible individuals substance use disorder treatment and recovery services.

History: Effective July 1, 2016; amended effective April 1, 2020; July 1, 2022; April 1, 2024.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-02. Application for program participation in the substance use disorder treatment

voucher system.
The department shall approve or deny a program's application within twenty working days of
receipt of a complete application. The department may declare an application withdrawn if an applicant
fails to submit all required documentation within sixty days of the department's notification to the
applicant that the application is incomplete. A complete application includes:
1. A signed application in the form and manner prescribed by the department;
2. A signed agreement pursuant to section 75-09.1-11-05;
3. Receipt of the program's policies:
a. Ensuring compliance with this chapter;
b. Ensuring that a screening is completed to determine an individual's need for further
assessment of a substance use disorder;
c. Ensuring that a screening is completed to determine financial eligibility consistent with
the individual eligibility criteria in subsection 5 of section 75-09.1-11-07;
d. Defining specific ASAM level of care services provided through the substance use
disorder treatment voucher system;
e. Ensuring that only appropriately licensed or certified staff are providing the specific level
of care service that is being reimbursed through the voucher system;
f. Identifying services based on best practice, including individualized, trauma-informed,
recovery-oriented, and person-centered programming for reimbursement through the
substance use disorder voucher system;
g. Defining specific procedures to ensure reporting of process measures and outcomes
measures consistent with department requirements;
h. Defining and developing specific procedures to ensure timely and accurate billing for
services qualifying for reimbursement through the voucher system;
i. Defining procedures allowing the department access to records; and
j. Ensuring the reporting of any change in licensing status to the department; and
4. A completed assessment of need and receipt of approval from the department for an out-of-
state program located within a bordering state.
History: Effective July 1, 2016; amended effective July 1, 2022.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-03. Program denials and revocations.

1. A program's application to participate in the voucher system may be denied if:
a. The program is:

(1) Not currently licensed under chapter 75-09.1-01;
(2) Not currently licensed as an out-of-state program located within a bordering state; or
(3) Currently licensed as an out-of-state program located within a bordering state and
has not received an assessment of need approval from the department;
b. The program is currently operating under a restricted license pursuant to subsection 2 of
section 75-09.1-01-03 or a similar license restriction for an out-of-state program located
within a bordering state; or
c. The program's policies submitted to the department in accordance with subsection 3 of
section 75-09.1-11-02 fail to ensure compliance with this chapter.
2. A program's participation in the voucher system may be revoked for failure to:
a. Comply with the terms and conditions of the signed agreement between the program and
the department;
b. Maintain licensing status in accordance with chapter 75-09.1-01 or similar license for an
out-of-state program located within a bordering state;
c. Comply with or enforce the program's policies submitted as required by subsection 3 of
section 75-09.1-11-02;
d. Properly document and submit a request for a substance use disorder treatment voucher
as required by section 75-09.1-11-08;
e. Provide a request for services covered by section 75-09.1-11-06;
f. Comply with section 75-09.1-11-13; or
g. Maintain, as an out-of-state program, an assessment of need approval from the
department.
3. Payment on a voucher may be denied if:
a. A revocation of the program's participation in the voucher system has occurred prior to
the date the service identified on the voucher was provided;
b. The program fails to comply with the terms and conditions of the signed agreement
between the program and the department;
c. The out-of-state program fails to maintain an assessment of need approval from the
department;
d. The program fails to comply with or enforce the program's policies submitted as required
by subsection 3 of section 75-09.1-11-02;
e. The program does not have a valid substance abuse treatment program license on the
date the service identified on the voucher was provided;
f. The program fails to properly document and submit a request for substance use disorder
treatment voucher in accordance with section 75-09.1-11-08;
g. The program submits a voucher for a service that is not identified as a service provided
under section 75-09.1-11-06;

h. The program submits a voucher for a service that the program is not approved to
provide; or
i. The program fails to comply with section 75-09.1-11-13.
History: Effective July 1, 2016; amended effective July 1, 2022.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-04. Program review.

1. A program whose application to participate in or payment through the substance use disorder
treatment voucher system is denied or revoked may request a review of the decision by filing,
within thirty days of the date of the department's notice of denial or revocation, a written notice
with the department which includes a statement of each disputed item and the reason for the
dispute.
2. A provider may not request review under this section if the denial or revocation is of a result of
an exhaustion of appropriated funds for the substance use disorder treatment voucher
system, provider no longer being licensed under article 75-09.1, submission of an invalid
voucher, or the provider's application being considered withdrawn.
3. Within thirty days after requesting a review, a provider shall provide to the department all
documents, written statements, exhibits, and other written information that supports the
request for review.
4. The department shall assign a provider's request for review to someone other than an
individual who was involved in the denial or revocation. A provider who has requested review
may contact the department for an informal conference regarding the review any time before
the department has issued its final decision.
5. The department shall make and issue its final decision within seventy-five days of receipt of
the notice of request for review. The department's final decision must conform to the
requirements of North Dakota Century Code section 28-32-39. A provider may appeal the final
decision of the department to the district court in the manner provided in North Dakota
Century Code section 28-32-42, and the district court shall review the department's final
decision in the manner provided in North Dakota Century Code section 28-32-46. The
judgment of the district court in an appeal from a request for review may be reviewed in the
supreme court on appeal by any party in the same manner as provided in North Dakota
Century Code section 28-32-49.
6. Upon receipt of notice that the provider has appealed its final decision to the district court, the
department shall make a record of all documents, written statements, exhibits, and other
written information submitted by the provider, affiliate, or the department in connection with the
request for review and the department's final decision on review, which constitutes the entire
record. Within thirty days after an appeal has been taken to district court as provided in this
section, the department shall prepare and file in the office of the clerk of the district court in
which the appeal is pending the original or a certified copy of the entire record, and that record
must be treated as the record on appeal for purposes of North Dakota Century Code section
28-32-44.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42

### § 75-09.1-11-05. Agreement required.

The department shall enter an agreement with an eligible program in a form and manner prescribed
by the department.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-06. Services qualifying for and reimbursed by the substance use disorder

treatment voucher system.
The department shall issue a voucher, if approved under section 75-09.1-11-08, as intent of
payment for a specific qualifying service for each of the following services:
1. Screening. A program may submit a request for payment for screening to determine the need
for further assessment of a substance use disorder.
2. Assessment. A program may submit a request for payment for a comprehensive
biopsychosocial clinical assessment that complies with section 75-09.1-01-14 when an
appropriate screening process has been completed, documented, and supports the need. The
program shall inform the individual of the option of a voucher. If the assessment does not
result in a recommendation for services consistent with ASAM criteria no further vouchers will
be issued.
3. Treatment. A program may submit a request for payment for treatment when there is a
biopsychosocial clinical assessment that complies with assessment requirements in article
75-09.1, the assessment has been completed within the last six months, and the department
has approved the recommendations. The program shall inform the individual of the option of a
voucher.
4. Recovery support services. A program may submit a request for payment for recovery support
services when the need for those services is documented in a comprehensive biopsychosocial
clinical assessment or an updated treatment plan. A voucher for recovery support services
may be issued as payment for recovery support services while the individual is awaiting
clinical treatment, during clinical treatment, or during extended treatment.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-07. Individual eligibility for a substance use disorder treatment voucher.

1. The individual completes a voucher application in the form and manner prescribed by the
department;
2. The individual resides in North Dakota;
3. The individual is twelve years of age or older;
4. The individual grants the department access to treatment and payment records consistent
with the confidentiality requirements found under title 42, Code of Federal Regulations, part 2
and title 45, Code of Federal Regulations, part 164;
5. The individual does not have resources to cover any care for treatment or meets one of the
following conditions:
a. Individual's third-party payment resources will not cover all costs for treatment;

b. Individual has a pending application for medical assistance which presents a barrier to
timely access to treatment; or
c. Individual would not qualify for medical assistance and has no alternative third-party
payment resources.
6. The individual has an annual income no greater than two hundred percent of federal poverty
guidelines.
History: Effective July 1, 2016; amended effective April 1, 2020; July 1, 2022; April 1, 2024.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-08. Approval of an individual's application and voucher.

1. A program shall submit the individual's voucher application and proper documentation to the
department requesting a substance use disorder treatment voucher for screening,
assessment, treatment, or recovery support services. A licensed professional operating within
their scope of practice or a certified peer support specialist acting consistent with training and
certification who is employed by a program approved to participate in the substance use
disorder treatment voucher system can provide services under the voucher system.
Documentation submitted by the program must be in the form and manner prescribed by the
department and must be in compliance with established requirements for each voucher
request.
2. An approved substance use disorder voucher must be activated for ninety days. If the service
is not initiated within ninety days the voucher will no longer be valid and a new voucher will
need to be requested. Vouchers will allow payment at the rate established by the department
for the specific ASAM service indicated. A new voucher will have to be activated for each
service identified under section 75-09.1-11-06.
3. Within five working days of receiving a request for a voucher, the department shall notify the
program submitting the request and the individual completing the application of the application
approval. The department shall notify the individual of the programs that provide the specific
service covered by the voucher.
History: Effective July 1, 2016; amended effective July 1, 2022.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-09. Denial of substance use disorder treatment voucher.

1. The department shall notify the program submitting the voucher application and the individual
requesting the voucher within five working days of receipt of a request for voucher that the
voucher application is denied. The department shall notify the program that submitted the
voucher within five working days of a voucher revocation. The department shall deny the
individual's voucher application if:
a. The individual is not eligible pursuant to section 75-09.1-11-07; or
b. The program submits a voucher application for a service that is not identified as a service
provided under section 75-09.1-11-06.
2. The department shall inform the individual requesting the voucher of the reason for the denial
and that the individual may appeal the denial.
History: Effective July 1, 2016.

General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-10. Appeals of denials of eligibility for substance use disorder treatment voucher.

An individual who has requested a substance use disorder treatment voucher may appeal a
decision to deny the voucher. An appeal under this section must be made in writing on a form
developed and provided by the department within thirty days of the date of the notice issued under
section 75-09.1-11-09. An individual shall submit the written request for an appeal and hearing under
North Dakota Century Code chapter 28-32 to the appeals supervisor for the department. An individual
may not appeal a denial resulting from an exhaustion of appropriated funds for the substance use
disorder treatment voucher system or an invalid voucher.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-11. Exceptions to eligibility rules considered.

An individual or a program on behalf of an individual may request an exception to the eligibility
criteria. Exceptions will be considered with regard to an individual meeting the eligibility criteria.
Exception requests will be reviewed on a case-by-case basis. The department may deny an exception
and may revoke an exception granted under this subsection. The decision to deny or revoke an
exception is not an appealable decision.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-12. Process measures and outcomes measures reports required.

Programs receiving payments for services through the voucher system shall collect and report
process measures and outcomes measures data to the department as determined by the department.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-13. Reimbursement process.

Voucher system payments will be issued for only those services meeting the ASAM criteria for
levels of care and for the specific, unbundled services provided using a standardized rate schedule.
The program shall submit requests for voucher system payments to the department and the
department shall issue payment after the program submits the reports required in section
75-09.1-11-12.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
### § 75-09.1-11-14. Training and technical assistance.

The department shall provide training and technical assistance to all programs that apply to
participate in the substance use disorder voucher system. All approved programs shall participate in the
following training:
1. The implementation of the substance use disorder voucher system;

2. Determining individual eligibility;
3. The process and documentation required to submit requests for substance use disorder
voucher approval;
4. The process and documentation required to submit billing for services that may be paid
through the substance use disorder voucher system;
5. Department-approved standards regarding best practices; and
6. Reporting requirements.
History: Effective July 1, 2016.
General Authority: NDCC 50-06-16
Law Implemented: NDCC 50-06-42
