# Title 23 — Health and Safety

## Chapter 23-17.3 — Home Health Agency Licensure

### § 23-17.3-01. Definitions.

In this chapter, unless the context and subject matter otherwise require:
1. "Allowed practitioner" means a physician assistant or advanced practice registered
nurse.
2. "Clinical record" means a written account which covers the services the agency
provides directly and those provided through arrangements with another agency which
account contains pertinent past and current medical, nursing, social, and other
therapeutic information, including the plan of treatment.
3. "Department" means the department of health and human services.
4. "Home health agency" means a public or private agency, organization, facility, or
subdivision thereof which is engaged in providing home health services to individuals
and families where they are presently residing for the purpose of preventing disease
and promoting, maintaining, or restoring health or minimizing the effects of illness or
disability.
5. "Home health aide" means an individual who renders personal related service under
the supervision of a registered professional nurse.
6. "Home health services" means a broad range of health and social services furnished
to individuals and families by a home health agency or by others under arrangements
with the agency, in the places where the recipients are presently residing. Services
must include the services of a currently licensed registered professional nurse and at
least one other therapeutic service and may include additional support services. These
services may only be provided with the approval of a licensed physician or an allowed
practitioner.
7. "Licensed practical nurse" means one who has met all legal requirements for licensure
and holds a current license to practice in North Dakota pursuant to chapter 43-12.1.
8. "Nursing services" means those services pertaining to the preventive, curative, and
restorative aspects of nursing care that are performed by or under the supervision of a
registered professional nurse.
9. "Person" means an individual, firm, partnership, association, corporation, limited
liability company, or any other entity, whether organized for profit or not.
10. "Physician" means any person currently licensed pursuant to chapter 43-17.
11. "Registered professional nurse" means a registered nurse as defined under chapter
43-12.1.
12. "Skilled nursing" means professional nursing services rendered by nurses licensed
under chapter 43-12.1.
13. "Supportive services" includes the use of medical appliances; medical supplies, other
than drugs and biologicals prescribed by a physician; the collection of blood and other
samples for laboratory analysis; and nutritional guidance, homemaker, or companion
services.
14. "Therapeutic services" means services which include:
a. Skilled nursing care.
b. Medical social services.
c. Home health aide services.
d. Physical, occupational, or speech therapy.
e. Respiratory therapy.
### § 23-17.3-02. License required - Rules.

A person may not conduct, maintain, or operate a home health agency without a license
issued by the department. The department shall adopt rules for the application, issuance, and
renewal of a license.

### § 23-17.3-03. Certificate of need required.

Repealed by S.L. 1995, ch. 254, § 6.
### § 23-17.3-04. Issuance and renewal of licenses - Evaluation.

On receipt of an initial or renewal application, the department or its authorized agent shall
evaluate the home health agency. If minimum standards described in section 23-17.3-05 are
met, the department shall issue the license for renewal.
### § 23-17.3-05. Standards of licensure.

1. Minimum standards which a home health agency must meet for licensure are:
a. The agency shall provide skilled nursing and at least one other therapeutic
service, such as physical therapy, occupational therapy, speech therapy, medical
social services, or home health aide services, on a regular basis.
b. The agency shall maintain personnel folders on all agency employees, which
indicate that qualified personnel are available to render designated services.
When hospital or long-term care personnel are utilized by the hospital or
long-term care facility to treat agency patients during the normal working hours,
the hospital's or facility's personnel folder meets this requirement for that facility's
employees. Home health agencies that contract for staff to provide services shall
maintain a current written agreement with personnel serving under that contract
in the personnel folders maintained under this subsection.
c. The agency shall maintain plans of treatment, clinical notes, and other means to
verify that services are actually provided and not merely listed as being offered.
d. The agency shall maintain full information in its files relating to ownership of the
agency. If the agency is incorporated for profit, the files must contain names and
addresses of the corporate officers and of each person having ten percent or
greater interest in the ownership of the agency.
e. The agency shall have a supervising physician or a supervising registered
professional nurse who is responsible for the direction, coordination, and general
supervision of the therapeutic services provided by the agency and who is
employed on a full-time basis. There must be supervision from a physician or
registered professional nurse during all hours of operation.
f. If services are to be provided by arrangement with other agencies or
organizations, the home health agency shall ensure that the other agencies or
organizations furnish qualified and trained personnel.
g. If services are provided under written contracts between a home health agency
and other agencies or other organizations, the home health agency shall have
documentation which verifies that communications between the contractor and
the staff of the agency are frequent, and that the home health agency has all
information necessary to assure that the administrative responsibility for the care
of patients rests with the home health agency.
h. The agency shall maintain clinical records on all patients to serve as
documentation of the medical, nursing, and therapeutic care rendered to the
patient and for communication between the physician or allowed practitioner and
the agency.
i. The agency shall ensure that home health aides are properly trained and function
under adequate supervision.
2. All phases of an agency's operation must be without discrimination against individuals
or groups of individuals on the basis of race, creed, color, national origin, sex, or age.
### § 23-17.3-06. Advice and consultation.

The department shall provide professional advice and consultation related to the quality of
home health agency aspects of health care and services provided by the licensee.

### § 23-17.3-07. Denial, suspension, or revocation of license.

The department may deny, suspend, or revoke a license for noncompliance with this
chapter in accordance with the administrative hearing provisions of chapter 28-32.
### § 23-17.3-08. Rules.

The department shall adopt necessary rules relating to the home health agencies licensed
pursuant to section 23-17.3-02, including rules governing:
1. Qualifications of professional and ancillary personnel in order to furnish adequately
home health services.
2. Standards for the organization and quality of patient care.
3. Procedures for maintaining records.
4. Provision for contractual arrangements for professional and ancillary health services.
5. Procedures for application, issuance, and renewal of license.
6. Procedures for denial, suspension, or revocation of license.
7. Inspections of licensed home health agencies.
### § 23-17.3-09. Inspections - Required information.

1. The department is authorized to conduct periodic inspections of the facilities of
licensed home health agencies with respect to fitness and adequacy of equipment,
personnel, rules and bylaws, standards of service and medical care, plans of
treatment, records, and other standards of licensure.
2. Any home health agency which provides or makes available any home health services
to the public in this state, in any organized program developed or rendered under its
auspices or provided under contract with any other person, shall submit annually to the
department a complete description of that home health agency's operation, including
name, address, location, or principal place of business, ownership, identification of
administrative personnel responsible for home health services, and the nature and
extent of the programs. The department shall determine the form and content of the
information compiled and the annual date for submission of information. The
department shall make the information available to the appropriate governmental
agencies of the state so as to make known the availability of home health services to
provide data for planning and for health needs of the people of the state. The
information must be available to the public and to the health systems agencies.
### § 23-17.3-10. Information confidential.

Information received under this chapter by the department, through inspection or otherwise,
is confidential and may not be disclosed except:
1. In a proceeding involving the question of license;
2. In a judicial proceeding, upon a court order; or
3. To a health or social services agency with specific responsibility for a patient's care.
