# Title 50 — Public Welfare

## Chapter 50-24.5 — Aid to Aged, Blind, and Disabled Persons

### § 50-24.5-01. Definitions.

In this chapter, unless the context otherwise requires:
1. "Adult residential facility" means a licensed basic care facility that meets the program
and provider requirements of the Medicaid 1915(c) home and community-based
services aged and disabled waiver, specializing in the care of individuals eligible for
services under a medical assistance home and community-based waiver or similar
program with chronic moderate to severe memory loss or significant emotional,
behavioral, or cognitive impairment, which provides therapeutic, social, and
recreational programming and assistance with activities of daily living and instrumental
activities of daily living.
2. "Aged" means at least sixty-five years of age.
3. "Blind" has the same meaning as the term has when used by the social security
administration in the supplemental security income program under titles II and XVI of
the Social Security Act [42 U.S.C. 401-434 and 42 U.S.C. 1381 et seq.].
4. "Congregate housing" means housing shared by two or more individuals not related to
each other which is not provided in an institution.
5. "Department" means the department of health and human services.
6. "Disabled" has the same meaning as the term has when used by the social security
administration in the supplemental security income program under titles II and XVI of
the Social Security Act [42 U.S.C. 401-434 and 42 U.S.C. 1381 et seq.].
7. "Eligible beneficiary" means a resident of this state who:
a. (1) Is aged; or
(2) Is at least eighteen years of age and is disabled or blind;
b. (1) Has applied for and is eligible to receive and receives benefits under title
XIX of the Social Security Act [42 U.S.C. 1396 et seq.], and who has applied
for and is receiving benefits, if the individual is eligible to receive benefits,
under titles II and XVI of the Social Security Act [42 U.S.C. 401-434 and
42 U.S.C. 1381 et seq.]; or
(2) Has applied for and is eligible to receive and receives benefits under section
established under title XIX of the Social Security Act [42 U.S.C. 1396
et seq.] and section 50-24.1-02;
c. Meets the requirements of section 23-09.3-08.1;
d. Based on a functional assessment, is not severely impaired in any of the activities
of daily living of toileting, transferring to or from a bed or chair, or eating and:
(1) Has health, welfare, or safety needs, including a need for supervision or a
structured environment; or
(2) Is impaired in three of the following four instrumental activities of daily living:
preparing meals, doing housework, taking medicine, and doing laundry; and
e. Is determined to be eligible pursuant to rules adopted by the department.
8. "Human service zone" means a county or consolidated group of counties
administering human services within a designated area in accordance with an
agreement or plan approved by the department.
9. "Institution" means a facility licensed under chapter 23-09.3.
10. "Living independently" includes living in congregate housing. The term does not
include living in an institution.
11. "Personal needs allowance" means an amount retained by the eligible beneficiary to
cover the costs of clothing and other personal needs.
12. "Proprietor" means an individual responsible for day-to-day administration and
management of a facility.
13. "Remedial care" means services that produce the maximum reduction of an eligible
beneficiary's physical or mental disability and the restoration of an eligible beneficiary
to the beneficiary's best possible functional level.

14. "Would be eligible to receive the cash benefits except for income" refers to an
individual whose countable income, less the cost of necessary remedial care that may
be provided under this chapter, does not exceed an amount equal to the cash benefit
under titles II and XVI of the Social Security Act [42 U.S.C. 401-434 and
42 U.S.C. 1381 et seq.] which the individual would receive if the individual had no
income, plus the amount allowed as the personal needs allowance.
### § 50-24.5-02. Powers and duties of the department.

The department shall:
1. Administer aid to vulnerable aged, blind, and disabled persons and supervise and
direct human service zones in the administration of aid to vulnerable aged, blind, and
disabled persons.
2. Supplement, within the limits of legislative appropriation, the income of an eligible
beneficiary receiving necessary basic care services to the extent that the eligible
beneficiary lacks income sufficient to meet the cost of that care, provided at rates
determined by the department adjusted by the inflation rate for basic care services
used to develop the legislative appropriation for the department.
3. Pay qualified basic care providers at rates determined by the department, within the
limits of legislative appropriation.
4. Issue payment to basic care facilities for services provided to an eligible beneficiary.
5. Take action and give directions necessary to implement this chapter.
### § 50-24.5-02.1. Registration of assisted living facilities.

Repealed by S.L. 2003, ch. 429, § 5.
### § 50-24.5-02.2. Basic care facility private room rates.

The department shall allow a basic care facility to charge a higher rate for a private room
used by a recipient of benefits under this chapter if the private room is not necessary to meet
the resident's care needs; the resident, or a person acting on behalf of the resident, has
requested the private room and the facility informs the person making the request, at the time of
the request, of the amount of payment and that the payment must come from sources other
than a resident's monthly income; and the payment does not exceed the amount charged to
private pay residents.
### § 50-24.5-02.3. Basic care payment rates.

1. The department shall determine limits for the care of residents of basic care facilities
that qualify as vendors of an aged, blind, and disabled persons program and for
implementing provisions of this chapter based on data demonstrating the most recent
costs that must be incurred for the care of residents in efficiently and economically
operated basic care facilities. The department shall determine the limits every four
years by July first, beginning with July 1, 2023.
2. The department shall establish the limits by using the median rates from the most
recent data available. The direct care limit must be the median plus eighteen percent.
The indirect care limit must be the median plus twelve percent.
3. For the rate year beginning July 1, 2023, the department shall increase rates and limits
three and one-half percent for inflation. For the rate year beginning July 1, 2024, the
department shall increase rates and limits three and one-half percent for inflation.
4. The department shall provide a rate increase in the amount of five dollars per day for
the period beginning July 1, 2023, and ending June 30, 2027, after which the increase
is not effective. This rate increase may not be included in any calculation of inflation
increase.
5. Within the limits of legislative appropriations, the department shall establish an
uncompensated care expense of three hundred sixty-five days.

### § 50-24.5-02.4. Adult residential facility payment rates - Report.

1. The department shall require an adult residential facility to submit cost reports and
supplemental information by October 31, 2025, which the department shall use to pay
the facility its current costs beginning January 1, 2026.
2. The department shall require adult residential facilities to submit cost reports and
supplemental information by December 31, 2026, which the department shall use to
provide a rate recalculation beginning July 1, 2027.
### § 50-24.5-03. Powers and duties of human service zone.

Each human service zone, unless otherwise directed or determined by the department,
shall:
1. Administer aid to aged, blind, and disabled persons at the human service zone level
under the direction and supervision of the department, pursuant to state requirements.
2. Provide the services described in this chapter.
3. Determine eligibility for benefits under this chapter and periodically redetermine
eligibility of persons receiving benefits pursuant to this chapter.
4. Provide case management services to eligible beneficiaries.
5. Conduct initial and ongoing functional assessments of applicants in cooperation with
basic care facilities.
6. Cooperate with any other human service zone to assure the conduct of initial and
ongoing functional assessments and determinations of eligibility with respect to any
applicant or eligible beneficiary who is physically present in a human service zone
other than the human service zone in which the applicant or eligible beneficiary is a
resident for purposes of chapter 50-01.
### § 50-24.5-04. Services provided - Limit on cost.

Services provided under this chapter must be treated as necessary remedial care to the
extent those services are not covered under the medical assistance program. The cost of the
services provided under this chapter to a person residing in a basic care facility for which the
rate charged includes room and board is limited to the rate set for services in that facility, plus
the amount allowed as the personal needs allowance, less that person's total income.
### § 50-24.5-05. Applicant's or guardian's duty to establish eligibility.

The applicant or guardian of the applicant shall provide information sufficient to establish
eligibility for benefits, including a social security number and proof of age, identity, residence,
blindness, disability, functional limitation, and financial eligibility for each month for which
benefits are sought.
### § 50-24.5-06. Appropriation of county funds - Reimbursement by department -

Reimbursement by county agency.
Repealed by S.L. 1997, ch. 403, § 13.
### § 50-24.5-07. Residency.

For purposes of this chapter:
1. A person is a resident of this state if:
a. The person is not living in an institution and is living in this state:
(1) With intent to remain in this state permanently or for an indefinite period; or
(2) Without intent if the person is incapable of stating intent.
b. The person is living in an institution outside this state and was receiving a benefit
under chapter 50-01 on January 1, 1995.
c. The person was placed in an out-of-state institution by a human service zone or
the department while the person was incapable of indicating intent.
d. The person is living in an in-state institution, has lived in that institution for at least
thirty days, and was not placed in that institution by another state. A person
placed in an institution by another state is a resident of the state making the

placement. Any action beyond providing information to the person and the
person's family constitutes arranging or making a state placement. However, the
following actions do not constitute state placement:
(1) Providing basic information about this chapter and information about the
availability of this chapter; or
(2) Assisting a person in locating an institution in this state, if the person is
capable of indicating intent and independently decides to move.
2. A person who is a resident of this state is a resident of the human service zone in
which the person is a resident for purposes of chapter 50-01.
### § 50-24.5-08. Department has preferred claim against estate.

Funds used to provide services to an eligible beneficiary may not be considered as gifts.
The department has a preferred claim against the estate of any person for recovery of funds
expended under this chapter for that person or that person's spouse or minor children. No
statute of limitations or similar statute nor the doctrine of laches bars a claim under this chapter.
### § 50-24.5-09. Responsibility for expenditures.

Expenditures required under this chapter are the responsibility of the state of North Dakota.
### § 50-24.5-10. Compensation for top management personnel - Department to adopt

emergency rules.
Notwithstanding the requirements of subsection 2 of section 28-32-03, the department has
the authority to create emergency rules related to the compensation for top management
personnel of a basic care facility combined with a hospital.
