N.D. Admin Code 75-02-02.4-01 - Definitions

As used in this chapter, unless the context or subject matter otherwise requires:

1. "Case manager" means the individual who coordinates and leads the person-centered planning process, and who provides each target population member with information about and assistance in accessing home and community-based services.

2. "Community provider" means an individual or entity that provides one or more home and community-based services, paid in whole or part by the department, to target population members.

3. "Department" means the North Dakota department of human services.

4. "Home and community-based services" means department-administered long-term services and supports that target population members are eligible to receive, and which are determined to be necessary through a person-centered planning process to serve target population members in the community.

5. "Informed choice" means:

a. The process by which the department ensures target population members have an opportunity to make an informed decision about where to receive services;

b. A choice made after the department has provided virtual or face-to-face person-centered planning and information about the benefits of integrated settings; which may include facilitated visits or other experiences in such settings; and offered opportunities to meet with other individuals with disabilities who are living, working, and receiving services in integrated settings, with their families, and with community providers; and

c. Making reasonable efforts to identify and address any concerns or objections raised by the target population member or another relevant decision maker.

6. "Most integrated setting" means a setting, determined through person-centered planning, that enables individuals with physical disabilities to interact with nondisabled persons to the fullest extent possible. The most integrated setting for a target population member usually will be a private residence owned or rented by the individual or their family member and in which the individual or their family member has property rights.

7. "Nursing facility level of care" means criteria that an individual must meet to be eligible to receive services provided by a nursing facility, pursuant to section 75-02-02-09.

8. "Person-centered planning" means:

a. A Medicaid-mandated process, which is driven by the individual, that identifies supports and services that are necessary to meet the individual's needs in the most integrated setting;

b. The individual directs the process to the maximum extent possible and is provided sufficient information and support to provide informed choice; and

c. The process is timely and occurs at times and locations convenient to the individual, reflects the cultural and linguistic considerations of the individual, provides information in plain language and in a manner that is accessible to individuals within the target population, and includes strategies for resolving conflict or disagreement that arises in the planning process.

9. "Physical disability" means an impairment, including age-related impairments, that substantially limits a major life activity, including one or more major bodily functions, that the individual meets nursing facility level of care.

10. "Public and private entities" include those organizations enrolled as North Dakota Medicaid providers who submit nursing facility level of care determinations for target population members in need of long-term care.

11. "Target population member" means an individual with a physical disability over the age of twenty-one who is eligible or likely to become eligible to receive Medicaid long-term services and supports and is likely to require such services for at least ninety days.

Notes

N.D. Admin Code 75-02-02.4-01

Adopted by Administrative Rules Supplement 2020-379, January 2021, effective 1/1/2021.

General Authority: NDCC 50-06-16, 50-06.2-03(6)

Law Implemented: 42 USC 12102; 28 CFR 35, Appendix B; 28 CFR 35.108; 42 CFR 441.725; S.L. 2019, ch. 37, § 44