Definitions 525-05-05

The willful act or omission of a caregiver or any other person which results in physical injury, mental anguish, unreasonable confinement, sexual abuse or exploitation, or financial exploitation to or of a vulnerable adult.

Tasks of a personal nature that are performed daily which involves such activities as bathing, dressing, toileting, transferring from bed or chair, continence, eating/feeding, and mobility inside the home.

An evaluation to identify adaptive devices, equipment, or modications that enhance the independence and functional capabilities of an individual who may otherwise be unable to remain in the individual’s home.

All persons eighteen years of age and over are adults. Children who are adults should not be considered the responsibility of their parents, even if living in the same household.

A program of non-residential activities provided at least three (3) hours per day on a regularly scheduled basis one or more days per week and encompasses both health and social services needed to insure the optimal functioning of the individual.

An adult day care program operated in a public accessible building. The program shall operate a minimum of three hours per day up to a maximum of ten hours per day.

An adult day care program operated in a private residence. The program shall operate a minimum of three hours per day up to a maximum of ten hours per day. The maximum number of participants in the home at any one time shall be no more than four.

The provision of food, shelter, security and safety, guidance, and comfort on a twenty-four-hour per day basis, in the home of the caregiver, to a person age eighteen or older, who is unable, neglects, or refuses to provide for the person's own care.

An occupied private residence in which Adult Family Foster Care is regularly provided by the owner or lessee thereof, to four or fewer adults who are not related by blood or marriage to the owner or lessee, for hire or compensation. (For additional Adult Family Foster Care definitions – see the Adult Family Foster Care Licensing.)

A facility in which at least five (5) unrelated adults reside, and in which personal care, therapeutic, social and recreational programming is provided in conjunction with residing in the facility. This service includes 24-hour on-site response staff to meet scheduled and unpredictable needs and to provide supervision, safety, and security.

An agency that enrolls with the Department of Human Services as a Qualified Service Provider, which allows that agency to bill the Department of Human Services for services rendered. Agency providers can include Department of Human Services, Human Service Centers, and County Social Service Boards.

A Division within the Department of Human Services within the Program and Policy’s organizational structure.

A financial benefit given to a veteran from the Veterans Administration for assistance with personal care tasks. The amount of the "aid and attendance" must be considered as income in the Service Payments for the Elderly and Disabled (SPED) Program.

An individual making application for services. An applicant may have a legal representative seeking services on behalf of the individual.

For purposes of this Chapter, it means the setting in which daily personal care is provided. It includes the definition at North Dakota Century Code (N.D.C.C.) 50-32-01(1): “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 makes available individualized support services to accommodate an individual’s needs and abilities to maintain as much independence as possible.

A term that refers to devices, products, or equipment that enhance the ability of an individual with functional impairment(s) to engage in major life activities, actions, and tasks.

Attendant Care Services (ACS) is hands on care, of both a supportive and medical nature, specific to a client who is ventilator dependent for a minimum of 20 hours per day and includes nursing activities that have been delegated by the nurse manager to the ACS provider. ACS is an all-inclusive service that provides direct care to ventilator-dependent individuals to meet their care needs.

An agency staff member, who is a Licensed Social Worker (LSW) and who is responsible for completing a comprehensive assessment, developing and implementing of client’s plan of care for services.

HCBS Case Management is the process within the framework of generic social work practice of providing specialized assistance to aged and disabled individuals desiring and needing help in selecting and/or obtaining resources and services. This includes coordinating the delivery of the services in order to assist functionally impaired persons remain in the community in the most cost effective manner. The specialized assistance is based on the results of a comprehensive assessment.

The provision of one time, intermittent or occasional home tasks including heavy duty housecleaning, minor home maintenance, and walk maintenance. The service is provided to clients who reside in their own home or rental housing where the rental arrangement does not include these tasks. These services are only provided in cases where neither the recipient, nor anyone else in the household, is capable of performing or financially providing for them, and where no other relative, caretaker, landlord, community volunteer/agency or third party payer is capable of or responsible for their provision. Emergency Response Systems (ERS) services are considered as a Chore Service.

An individual who has met the eligibility criteria for services under the provision of this chapter.

The skills and abilities required to complete a task or activity to an established standard.

Instrument used to record basic demographic and medical information about an individual, including age, date of birth, spoken language, marital status, household members, emergency contacts, medical resources, health care coverage, and source and reason for referral, and to secure measurable information regarding: physical health, cognitive and emotional functioning, activities of daily living, instrumental activities of daily living, informal supports, need for twenty-four hour supervision, social participation, physical environment, financial resources, and other information not recorded elsewhere.

A congenital disability is one that exists at birth or shortly thereafter and for this chapter is not attributable to a diagnosis of either intellectual disability or a closely related condition.

Congregate housing means housing shared by two or more persons not related to each other which is not provided in an institution. N.D.C.C. 50-24.5-01(3)

The specific county social service board serving the county in which the applicant/client physically lives.

Services specified in the Department’s approved Medicaid Waiver for Home and Community Based Services, Service Payments for the Elderly and Disabled, Expanded Service Payments for the Elderly and Disabled, and Medicaid State Plan Targeted Case Management.

Any individual who the applicant/client is legally responsible to provide support and care: minor child, spouse, anyone placed in the care of the applicant/client by court order.

This is a disability that results from an assault (injury) that occurs externally (e.g. blow to head, accident, fall) or internally within the body (e.g. stroke, heart attack).

Means a disability that results from an assault that occurs internally within the body.

As defined by the Social Security Administration: the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than twelve (12) months (or, in the case of a child under the age of 18, if suffering from any medically determinable physical or mental impairment of comparable severity).

A person under age sixty-five who has a congenital disability, a disability due to trauma, or an acquired disability. (N.D.A.C. 75-03-23)

As defined in North Dakota Century Code chapter 50-06.2 means a transfer made at any time before or after an individual makes application for SPED benefits by which the individual or the individual’s spouse has made any assignment or transfer of any asset for the purpose of making that individual eligible for benefits. Assignment or transfer includes any action or failure to act that effects a transfer, renunciation, or disclaimer of any asset or interest in an asset that the individual otherwise might assert or have asserted, or which serves to reduce the amount that an individual might otherwise claim from a decedent’s estate, a trust or similar device, or another individual obligated by law to furnish support.

Physical adaptations to the home necessary to ensure the health, welfare and safety of the client or enables the client to function with greater independence in their home.

An electronic device enabling the client to secure help in an emergency by activating the “help” button he/she is wearing. The system is connected to the client’s phone and programmed to signal a response center once a “help” button is activated.

The act or process of an individual using the income, assets, or person of another individual for monetary or personal benefit, profit, gain, or gratification.

A Family Caregiver is a person who lives with or provides daily care to an eligible client and may include a spouse, children, relatives, foster family, or in-laws.

The provision of room, board, supervisory care, and personal services daily, to an eligible elderly or disabled person by a qualified service provider, in the home of the client or the home of the qualified service provider who meets the definition of a family member as defined in N.D.C.C 50-06.2-02(4).

Such information about a family's assets, income, and medical deductions as is necessary and reasonably requested for the purpose of determining the fee to be charged.

An instrument used to record basic demographic and medical information about an individual, including age, date of birth, spoken language, marital status, individuals residing with, emergency contacts, medical resources, health care coverage, and source and reason for referral; and to secure measurable information regarding

The inability to perform, either by oneself or with adaptive aids or with human help, specic activities of daily living or instrumental activities of daily living.

A unit within the Department of Human Services’ Medical Services Division. HCBS Program Administration includes the programs of Targeted Case Management, Medicaid Waiver Home and Community Based Services, Service Payments for the Elderly and Disabled, and Expanded Service Payments for the Elderly and Disabled.

The array of services under the SPED program and medicaid waiver dened in the comprehensive human service plan and the other services the department determines to be essential and appropriate to sustain individuals in their homes and in their communities, and to delay or prevent institutional care.

An individual who meets the standards and performs tasks/activities under the provisions of this service chapter.

Provision of non-personal (environmental) care tasks such as light duty housekeeping, laundry, meal planning and preparation, and shopping that enables the individual to maintain independence.

When SPED financial eligibility, individuals to be included in a household count if residing together, include the recipient/applicant of services, spouse of the recipient/applicant, children and stepchildren under the age of 18 of the recipient/applicant, and any other individual that has been designated as a ward or dependent person of the applicant/recipient or the spouse by court order.

The document developed by a case manager and the client or legal representative specifying the frequency and intensity of each service to be received as an alternative to institutional care. Under the Medicaid Waiver for Home and Community Based Services, an interdisciplinary team will be involved in the development of the Care Plan of clients who receive the services of TBI Residential, TBI Transitional, and Supported Employment Service.

Family, neighbors, friends, church, and other private resources available to meet identified needs of a client.

Institution means an establishment that makes available some treatment or services beyond food or shelter to five or more persons who are not related to the proprietor. N.D.C.C. 50-24.5-01(8).

Includes complex life activities routinely performed by an individual such as housework, laundry, meal preparation, taking medication, shopping, outside mobility, transportation, management of money and use of a telephone.

A medical screening requested to determine eligibility for the Medicaid Waivers or to screen children for the SPED program. The Department contracts with a utilization control management team to establish medical need.

Any resource that can readily be converted to cash, and includes cash on hand, checking accounts, savings accounts, stocks, bonds, and other negotiable instruments as well as non-contracted crop in storage. Liquid assets include taxable, tax-exempt, and tax-deferred funds. For purposes of this chapter, liquid assets also includes the value of residences of the applicant or client other than their primary residence.

An applicant or client who lives alone or with a person(s) who is under the age of 18 or incapacitated is considered to be living alone.

Living independently includes living in congregate housing. The term does not include living in an institution.

A need for the services available under the SPED Program, ExSPED Program, Medicaid Waiver Program, or the Medicaid State Plan Personal Care Option that is be anticipated to exceed 30 days.

A Division within the Department of Human Services with administrative and programmatic responsibility for the Home and Community Based Services.

A federal program specifically provided for by Federal law enabling states to deliver, under waiver of several Medicaid requirements, services to aged and disabled persons at risk of institutionalization.

Psychological or emotional damage that requires medical treatment or care, or is characterized by behavioral changes, or mental illness.

Overseeing and periodically reviewing the client's progress, condition, and the quality and quantity of services provided.

The failure of an individual to provide the goods or services necessary to avoid physical harm, mental anguish, or mental illness.

Transportation provided to eligible clients which enables them to access essential community resources/services needed in order to maintain themselves in a home and community setting.

A facility licensed by the North Dakota Department of Health and Consolidated Laboratories to provide residential nursing and medical care.

A child's adoptive or biological mother, or father, or stepparent who has legal responsibility for a child.

A financial arrangement between the provider, the Department, and the county social service agency for services.

Personal Care Service is to help the individual with activities of daily living on an ongoing basis up to 24 hours per day, if necessary. Assistance with instrumental activities of daily living may also be provided in conjunction with the tasks for activities of daily living.

Damage to bodily tissue which includes fractures, bruises, lacerations, internal injuries, dislocations, physical pain, illness, or impairment of physical function.

The responsible person providing continuous care and supervision to an eligible individual that prevents institutionalization.

The home owned and occupied by the applicant as his/her main place of residence.

Not considered a "private family dwelling" is an institution, a dormitory, motel/hotel room, and other similar arrangements rented by the individual. Congregate/group meals may be available or meals may be eaten off site.

An individual or agency that has met all of the standards/requirements and has been designated by the Department of Human Services as a provider.

A Qualified Family Member is: the spouse or one of the following relatives, or the current or former spouse of one of the following relatives, of the elderly or disabled person: parent, grandparent, adult child, adult sibling, adult grandchild, adult niece, or adult nephew. (Current or former spouse refers to in-law relationships.)

A handbook outlining the standards and procedures required for agencies and individuals to qualify as a Qualified Service Provider.

An individual in at least one of the following categories: parent or stepparent; spouse, son or daughter, stepson or stepdaughter, grandson or granddaughter.

Any adult who is receiving foster care, in an Adult Family Foster Care Home for Adults or Residential Care for compensation on a 24-hour basis.

When personal care, therapeutic, social and recreational programming is provided in conjunction with residing in the facility. Includes 24-hour on-site response staff to meet client-resident needs and to provide supervision, safety and security. Resident is responsible for payment of board and room. Residential facilities must be licensed as Basic Care facilities.

Residential services are: state institutional facilities, nursing homes, residential child care facilities, developmental disability facilities, family foster homes and adult family (foster) homes licensed by the state of North Dakota.

Care to an eligible individual for a specified period of time for the purpose of providing temporary relief to the individual's primary caregiver from the stresses and demands associated with daily care or emergencies.

An individual enrolled as a qualified service provider who provides respite care to a client, whose care is funded by the county or state, in the absence of the provider.

The amount a SPED client is required to pay toward the cost of the client’s SPED services.

The payment issued by the Department to the caregiver/qualified service provider.

A state program under which Qualified Service Providers are reimbursed by the Department for the provision of certain services provided to eligible elderly and disabled persons. These services are designed to assist individuals to remain in their own homes and communities.

Conduct directed against an individual which constitutes any of those sex offenses defined in N.D.C.C. 12.1-20-02, 12.1-20-03, 12-1.20-04, 12.1-20-05, 12.1-20-06.

The document used to determine the SPED service fee to be assessed based on family size and income.

Components of Social History include: Demographics, Who lives in the Home, Health History, Family Structure, Coping Mechanisms, Support System, Educational and Employment History, Behavior/Psychological/Social Information, Financial Resources, Identification of Service Need, and Outcome of Services Provision.

Specialized equipment and supplies to include devices, controls, or appliances, specified in the plan of care, which enable recipients to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live.

The service payments for elderly and disabled program, a state program which authorizes the department to reimburse qualied service providers for the provision of covered home and community-based services to eligible aged and disabled individuals.

The list maintained by the department which contains the names of clients for whom SPED program funding is available when the clients’ names are transferred from the SPED program pool to SPED program active status.

The income of each spouse is deemed available to the other. When assets are to be considered, all assets of each spouse are deemed available to the other.

A level of quality or excellence that is accepted as the norm for a specific task.

Structural changes refers to alterations of the recipient's residence to accommodate specialized equipment or changes in design to facilitate self care.

A substantial inability, determined through observation, diagnosis, evaluation, or assessment, to live independently or provide self-care resulting from physical limitations.

A substantial disorder of thought, mood, perception, orientation, or memory, which grossly impairs judgement, behavior, or the ability to live independently, or provide for self-care, and which is determined by observation, diagnosis, evaluation, or assessment.

An individual who meets qualified service provider standards and provides respite care to private pay clients in the absence of the provider.

Provision of intensive, ongoing support to individuals to perform in a work setting with adaptations, supervision, and training relating to the person’s disability. This would not include supervisory or training activities provided in a typical business setting. This service is conducted in a work setting, mainly in a work site in which persons without disabilities are employed.

An insurance company, Medicare, Medicaid, governmental entity, health maintenance organization (HMO), special education, court, or other resource which is responsible for payment of services.

Provision of training an individual to live with greater independence in the individual’s home. This includes training, supervision, or assistance to the individual with self-care, communication skills, socialization, sensory/motor development, reduction/elimination of maladaptive behavior, community living, and mobility.

Assistance with retention or improvement in skills related to activities of daily living, such as personal grooming and cleanliness, bed-making and household chores, eating the preparation of food, and the social, behavior, and adaptive skills necessary to reside in a non-institutional setting.

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Home and Community Based Services Policies and Procedures 525-05

Definitions 525-05-05