Definitions 400-29-15

(Revised 10/01 ML #2738)

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(NDAC 75-02-10-01)

 

 

1. "Activities of daily living”  means bathing, dressing, toileting, transferring, eating, bed mobility, medication management, and individual hygiene.

2.  "Aged" means at least sixty-five years of age.

3. “Alzheimers and related dementia facility” means a licensed basic care facility which primarily provides services specifically for individuals with Alzheimer’s disease or related dementia. 

4.  “Applicant” means an individual, or proper person, seeking Basic Care Assistance benefits on behalf of another person, to a county agency.

5. "Assisted living" means an environment where a person lives in an apartment-like unit and receives services on a twenty-four-hour basis to accommodate that person's needs and abilities to maintain as much independence as possible. 

6. “Assisted living facility” means any building or structure containing a series of living units operated as one business entity to provide services for five or more individuals who are aged or disabled adults and who are not related by blood or marriage to the owner or manager of the entity and which is kept, used, maintained, advertised, or held out to the public as a place that takes available individualized support services to accommodate an individual’s needs and abilities to maintain as much independence as possible.  It does not include a facility that is licensed as a basic care facility or a congregate housing facility. 

7.  "Basic Care Facility" means a residence, not licensed under NDCC § 23-16 by the Department, that provides room and board to five or more individuals who are not related by blood or marriage to the owner or manager of the residence and who, because of impaired capacity for independent living, require health, social, or personal care services, but do not require regular twenty-four hour medical or nursing services and

1.  Makes response staff available at all times to meet the twenty-four hour per day scheduled and unscheduled needs of the individual; or,

2. Is kept, used, maintained, advertised, or held out to the public as an Alzheimer’s, dementia, or special memory care facility.

8. "Blind" has the same meaning as the term used by the Social Security Administration for the Supplemental Security Income Program under Title XVI of the Social Security Act.  [42 U.S.C. 1381 et seq.] 

9. “Congregate housing” means housing shared by two or more individuals not related to each other and receive services not provided in an institution. 

10. "Countable income" means gross income reduced by

1. The cost of guardianship or conservatorship fees actually charged, but no more than five percent of the monthly gross income;
2. All health insurance premiums including but not limited to Medicare health insurance supplements, cancer insurance, etc.  If the deduction is allowed for Medicaid in TECS, it must be allowed as a deduction for the Basic Care Assistance Program;
3. Court-ordered child support payments actually paid on behalf of a minor child who is not a member of the person’s Medicaid unit; and,
4. For persons receiving Basic Care Assistance:

   1. The month the person enters the basic care facility, the medically needy income level of the size of family in which the person was a member before entering the basic care facility; and

   2. Sixty-five dollars plus one-half of the remaining monthly gross earned income.

5. Medicaid recipient liability.
6. The Personal clothing allowance of $60.00 per month.

11.  "County agency" means the county social service board.

12. "Department" means the Department of Human Services.

13. “Disabled” has the same meaning as the term has when used by the Social Security Administration in the supplemental security income program under Title XVI of the Social Security Act [42 U.S.C. 1381 et seq.]. 

14. “Eligible beneficiary” means a resident of this State who:

1.  

   1. Is aged; or

   2. Is at least eighteen years of age and is disabled or blind:

2. Has applied for and is eligible to receive benefits under Title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], provided that an individual who was eligible to receive benefits under Title XVI of the Social Security Act [42 U.S.C. 1381 et seq.] and who was receiving benefits under Title XVI before January 1, 1995, is not ineligible because that individual is not eligible to receive benefits under Title XIX:

3.  Based on 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, which requires care in a licensed adult family foster care home or a licensed basic care facility; 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

4. Is determined to be eligible pursuant to rules adopted by the Department.

15. "Functional assessment" means an evaluation process based on the person's ability or inability to live independently.  The evaluation process is completed by the Home and Community Based Service case manager before entering a basic care facility.

16. "Functionalstatus" means a redetermination of the recipient's functional status at the time of redetermination for Medicaid eligibility. 

17.  "Grossincome" includes any income at the disposal of an applicant, recipient, or responsible relative; any income with respect to which an applicant, recipient, or responsible relative has a legal interest in a liquidated sum and the legal ability to make the sum available for support or maintenance; or any income an applicant, recipient, or responsible relative has the lawful power to make available or to cause to be made available.  It includes any income that would be applied in determining eligibility for benefits; any income, except occasional small gifts, that would be disregarded in determining eligibility for benefits; annuities, pensions, retirement, and disability benefits to which an applicant or recipient, or spouse of an applicant or recipient, may be entitled including veteran's compensation and pensions of any type, old-age survivors benefits, and disability insurance benefits; railroad retirement benefits; and unemployment benefits.

18. “Individualized support services” means services designed to provide assistance to adults who may have physical or cognitive impairments and who require at least a moderate level of assistance with one or more activities of daily living.
19. "Institution" means an establishment that makes available some treatment or services beyond food or shelter to four or more persons who are not related to the proprietor.

20. “Instrumental activities of daily living” means activities to support independent living including housekeeping, shopping, laundry, transportation, and meal preparation.

21.  "Livingindependently" includes living in congregate housing.  The term does not include living in an institution.

22.  “Living unit” means a portion of an assisted living facility occupied as the living quarters of an individual who has entered into a lease agreement with the assisted living facility. 

23. “Medical leave day” means a day a resident is not in the basic care facility due to a medical condition.

24. "Necessary benefits" means those benefits:

1. Provided under this program;

2. Identified by the department (or a county agency under the direction and supervision of the department) as appropriate to meet the needs of an applicant or recipient; and,

3. Which, when provided in coordination and conjunction with benefits available from any other source, represent the means least costly to the department of meeting the needs of the applicant or recipient.

25. “Proprietor” means an individual responsible for day-to-day administration and management of a facility. 

26.  "Proper individual" means any individuals of sufficient maturity and understanding to act responsibly on behalf of the applicant.

27. "Qualified service provider" means a county agency or independent contractor who agrees to meet standards for services and operations established by the department.

28. “Recipient responsibility” means the amount a recipient of the Basic Care Assistance Program is responsible for to the basic care facility.  The recipient responsibility cannot be offset by outstanding medical bills. 

29. “Related by blood or marriage to the owner or manager” means an individual who is a spouse or former spouse of the owner or manager or is a parent, stepparent, grandparent, stepgrandparent, child, stepchild, grandchild, stepgrandchild, brother, sister, half-brother, half-sister, stepbrother, or stepsister of the owner or manager of the owner or manager’s spouse or former spouse. 

30. “Related by the proprietor” means an individual who is a proprietor’s spouse or former spouse, or a parent, stepparent, grandparent, stepgrandparent, child, stepchild, grandchild, stepgrandchild, brother, sister, half-brother, half-sister, stepbrother, or stepsister, of a proprietor or proprietor’s spouse or former spouse. 

31.  “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.

32. “Resident” means an individual who has been admitted to the facility, but not discharged. 

33. “Residentday” in a facility means any day for which service is provided or for which payment in any amount is ordinarily sought, including medical care leave and therapeutic leave days.  The day of admission and the day of death are resident days.  The day of discharge is not a resident day. 

34.  “Tenant” means an adult individual who has entered into a lease agreement with an assisted living facility. 

35. “Therapeuticday leave” means any day that a resident is not in the facility or in a licensed health care facility other than a medical leave day.

36. "Totalincome" means countable income.

37.   “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 Title XVI of the Social Security Act [42 U.S.C. 1381 et seq.] which the individual would receive if the individual had no income, plus sixty dollars.