(Revised 11/5/21 ML #3640)
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Abuse
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.
Activities of Daily Living (ADLs)
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.
Adaptive Assessment
An evaluation to identify adaptive devices, equipment, or modifications that enhance the independence and functional capabilities of an individual who may otherwise be unable to remain in the individual’s home.
Adaptive Equipment
Equipment and supplies, which enable recipients to increase their abilities to perform ADLs. See also “Specialized Equipment and Supplies”.
Adult
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.
Adult Day Care (ADC) Service
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.
Adult Day Care (ADC) Center
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.
Adult Day Care (ADC) Home
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.
Adult Foster Care (AFC)
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.
Adult Foster Home/Facility
An occupied private residence in which Adult 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 Foster Care definitions – see the Adult Foster Care Licensing.)
Adult Residential Care Service (ARS)
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.
Aged
Means sixty-five years of age or older.
Agency - Qualified Service Provider (QSP)
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.
Aging Services Division
A Division within the Department of Human Services (DHS) within the Program and Policy’s organizational structure with administrative and programmatic responsibility for Home and Community Based Services (HCBS).
Aid and Attendance
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.
Applicant
An individual making application for services. An applicant may have a legal representative seeking services on behalf of the individual.
Assisted Living Facility
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.
Assistive Technology
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 Service
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.
Balance Due
The amount of fees for which a responsible party is billed and required to pay.
Case Manager (CM)
An agency staff member, who is a Licensed Social Worker (LBSW) and who is responsible for completing a comprehensive assessment, developing and implementing of client’s plan of care for services.
Case Management Service
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.
Chore Service
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.
Client
An individual who has met the eligibility criteria for services under the provision of this chapter.
Client Share
Monthly amount a SPED client is required to pay towards the cost of the client’s services. It works like a monthly deductible. This amount is determined after deducting allowable medical expenses from their countable income. See also “Cost Share” and/or “Service Fee”.
Community Support Services
Community supports is formalized training and supports provided to eligible individuals who require some level of ongoing daily support. This service is designed to assist with and develop self-help, socialization, and adaptive skills that improve the participant’s ability to independently reside and participate in an integrated community.
Community Transition Services (CTS)
Assists eligible individuals transitioning from an institution or another provider-operated living arrangement (to include skilled nursing facility, adult residential, adult foster care, basic care, and assisted living) to a living arrangement in a private residence where the client is directly responsible for his/her own living expenses and needs non-recurring set-up expenses.
Companionship Services
Reduces social isolation in older adults and individuals with physical disabilities. Companionship services are non-medical care, supervision and socialization, provided to a waiver recipient who lives alone or with an individual who is not capable or obligated to provide the service.
Competency Level
The skills and abilities required to complete a task or activity to an established standard.
Comprehensive Assessment
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.
Congenital Disability
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
Congregate housing means housing shared by two or more individuals not related to each other which is not provided in an institution. N.D.C.C. 50-24.5-01(3).
Cost Share
Monthly amount a SPED client is required to pay towards the cost of the client’s services. It works like a monthly deductible. This amount is determined after deducting allowable medical expenses from their countable income. See also “Client Share” and/or “Service Fee”.
County Social Service Board
The specific county social service board serving the county in which the applicant/client physically lives.
Covered Services
Services specified in the Department’s approved Medicaid Waiver (MW) for Home and Community Based Services (HCBS), Service Payments for the Elderly and Disabled (SPED), Expanded Service Payments for the Elderly and Disabled (Ex-SPED), and Medicaid State Plan Targeted Case Management (MSP-TCM).
Critical Incident Report (CIR)
A critical incident is any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the physical or mental health, safety or well-being of any client receiving HCBS.
Department
The North Dakota Department of Human Services (DHS).
Dependent
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.
Disability Due to Trauma
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).
Disability That Is Acquired
Means a disability that results from an assault that occurs internally within the body.
Disabled (Expanded SPED)
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).
Disabled (SPED and Medicaid Waiver)
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)
Disqualifying Transfer
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.
Emergency Response System (ERS)
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.
Endorsements
A task that requires special skills and approval.
Environmental Modification
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.
Expanded Service Payments for the Elderly and Disabled (Ex-SPED)
A state funded 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.
Ex-SPED Program Pool
The list maintained by the department which contains the names of clients for whom Ex-SPED program funding is available when the clients’ names are transferred from the Ex-SPED program pool to Ex-SPED program active status.
Exploitation
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.
Family Caregiver
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.
Family Home Care (FHC)
The provision of room, board, supervisory care, and personal services daily, to an eligible elderly or disabled person by a qualified service provider, who meets the definition of a family member as defined in N.D.C.C. 50-06.2-02(4), in the home of the client or the home of the qualified service provider.
Family Member
Defined as spouse or by 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.
Family Personal Care (FPC)
Assists individuals to remain with their family members and in their own communities. It provides for the provision of extraordinary care payments to the legal spouse of a recipient for the provision of personal care or similar services.
Fee Setting Authority
The North Dakota Department of Human Services.
Full Financial Information
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.
Full Service Fee
The usual and customary fee (maximum) per unit charge assigned to a service.
Functional Assessment
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
Functional Impairment
The inability to perform, either by oneself or with adaptive aids or with human help, specific activities of daily living or instrumental activities of daily living.
HCBS Program Administration
A unit within the Department of Human Services’ Aging Services Division. HCBS Program Administration includes the programs of Targeted Case Management, Medicaid Waiver Home and Community Based Services, Medicaid State Plan Personal Care, Service Payments for the Elderly and Disabled, and Expanded Service Payments for the Elderly and Disabled.
Home and Community-Based Services (HCBS)
The array of services under the SPED program and Medicaid Waiver defined 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.
Homemaker
An individual who meets the standards and performs tasks/activities under the provisions of this service chapter.
Homemaker Service (HMK)
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.
Household
When determining 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.
Income
Total adjusted gross monthly family income.
Individual Care Plan (ICP)
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.
Individual Program Plan (IPP)
An individualized plan, developed by the QSP, that describes the tasks or training that will be done for a client receiving Transitional Living Services or Community Transitions Services. The IPP demonstrates how the QSP will work toward the client’s goals.
Individual – Qualified Service Provider (QSP)
An individual who enrolls with the Department of Human Services as a Qualified Service Provider, which allows that individual to bill the Department of Human Services for services rendered.
Informal Network
Family, neighbors, friends, church, and other private resources available to meet identified needs of a client.
Institution
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).
Instrumental Activities of Daily Living (IADLs)
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.
Legally Responsible Person
Legal spouse or parent of a minor child.
Legal Representative
Someone who has been given power by law to represent another person.
Level-of-Care (LOC) Determination
A medical screening requested to determine eligibility for the Medicaid Waivers, Medicaid State Plan Levels B & C, or to screen children for the SPED program. The Department contracts with a utilization control management team to establish medical need.
Liquid Assets
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 include the value of residences of the applicant or client other than their primary residence.
Living Alone
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. If an applicant lives with a non-obligated adult, they would also be considered to be living alone.
Living Independently
Living independently includes living in congregate housing. The term does not include living in an institution.
Long Term Care Need
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.
Medical Services Division
A Division within the Department of Human Services with administrative responsibility to enroll Qualified Services Providers, conduct Qualified Service Provider audits, and set rates for HCBS services.
Medicaid State Plan Personal Care Program (MSP-PC)
Personal care services assist an individual with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), so that the individual is able to live at home. See MSP-PC Policy Manual (535-05).
Medicaid Waiver (MW)
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.
Mental Anguish
Psychological or emotional damage that requires medical treatment or care, or is characterized by behavioral changes, or mental illness.
Monitoring
Overseeing and periodically reviewing the client's progress, condition, and the quality and quantity of services provided.
Most Integrated Setting
A setting that enables an individual with a disability to interact with non-disabled persons to the fullest extent. The most integrated setting for an individual will usually be a private residence owned or rented by the individual or their family member.
Moving Expenses
Expenses that are necessary to assist an individual to move back to the community under Community Transition Services. See also “One-Time Set-Up Expenses”.
Neglect
The failure of an individual to provide the goods or services necessary to avoid physical harm, mental anguish, or mental illness.
Non-Medical Transportation (NMT)
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.
Nursing Facility (Long Term Care Facility)
A facility licensed by the North Dakota Department of Health and Consolidated Laboratories to provide residential nursing and medical care.
Obligated Family Member
A spouse, parent of a child under the age of 18, or a guardian (if required by the court to provide care).
Olmstead Decision
U.S. Supreme Court decision held under the Americans with Disabilities Act, that qualified individuals have the right to receive supports and services in the community rather than institutions.
One-Time Set-Up Expenses
Expenses that are necessary to assist an individual to move back to the community under Community Transition Services. See also “Moving Expenses”.
Parent
A child's adoptive or biological mother, or father, or stepparent who has legal responsibility for a child.
Payment for Care
A financial arrangement between the provider, the Department, and the county social service agency for services.
Personal Care (PC) Service
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.
Physical Injury
Damage to bodily tissue which includes fractures, bruises, lacerations, internal injuries, dislocations, physical pain, illness, or impairment of physical function.
Poor Care
Care that does not meet service standards or care that is not acceptable to the client or department.
Primary Caregiver
The responsible person providing continuous care and supervision to an eligible individual that prevents institutionalization.
Primary Residence
The home owned and occupied by the applicant as his/her main place of residence.
Dwelling is defined in NDCC 14-02.5-01(8) as any structure or part of a structure that is occupied as, or designed or intended for occupancy as, a residence by one or more families.
Not considered a "private family dwelling" is an institution, motel/hotel room, and other similar arrangements rented by the individual. Congregate/group meals may be available or meals may be eaten off site.
Qualified Service Provider (QSP)
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.
Qualified Service Provider (QSP) Handbook
A handbook outlining the standards and procedures required for agencies and individuals to qualify as a Qualified Service Provider.
Related by Blood or Marriage
An individual in at least one of the following categories: parent or stepparent; spouse, son or daughter, stepson or stepdaughter, grandson or granddaughter.
Resident
Any adult who is receiving foster care, in an Adult Foster Care Home for Adults or Residential Care for compensation on a 24-hour basis.
Residential Care Service
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 Habilitation
Formalized training and supports provided to eligible individuals who require some level of ongoing daily support. This service is designed to assist with and develop self-help, socialization, and adaptive skills that improve the participant’s ability to independently reside and participate in an integrated community.
Residential Services
Residential services are: state institutional facilities, nursing homes, residential child care facilities, developmental disability facilities, family foster homes and adult (foster) homes licensed by the state of North Dakota.
Respite Care Service
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.
Respite Care Provider
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.
Responsible Party
The individual responsible for paying for services.
Service Fee
Monthly amount a SPED client is required to pay towards the cost of the client’s services. It works like a monthly deductible. This amount is determined after deducting allowable medical expenses from their countable income. See also “Client Share” and/or “Cost Share”.
Service Payment
The payment issued by the Department to the caregiver/qualified service provider.
Service Payments for the Elderly and Disabled (SPED)
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.
Service Payments for the Elderly and Disabled (SPED) Program Pool
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.
Settings Rule
Centers for Medicare & Medicaid Services (CMS) issued a final rule that requires states to review and evaluate HCBS settings. States are required to ensure all HCBS settings comply with the new federal requirements to ensure that all individuals receiving HCBS are integrated in and have full access to their communities.
Sexual Abuse
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.
Sliding Fee Schedule
The document used to determine the SPED service fee to be assessed based on family size and income.
Social History
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
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.
Spousal Impoverishment
Spousal Impoverishment applies to the Medicaid Waiver programs only. Allows the spouse at home (the community spouse) to keep additional income and assets so he/she can continue to live independently.
Spousal Support
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.
Standard
A level of quality or excellence that is accepted as the norm for a specific task.
Structural Changes
Structural changes refer to alterations of the recipient's residence to accommodate specialized equipment or changes in design to facilitate self-care.
Substantial Functional Impairment
A substantial inability, determined through observation, diagnosis, evaluation, or assessment, to live independently or provide self-care resulting from physical limitations.
Substantial Mental Impairment
A substantial disorder of thought, mood, perception, orientation, or memory, which grossly impairs judgment, behavior, or the ability to live independently, or provide for self-care, and which is determined by observation, diagnosis, evaluation, or assessment.
Substitute Caregiver
An individual who meets qualified service provider standards and provides respite care to private pay clients in the absence of the provider.
Supervision
Up to 24 hours of supervision may be provided to eligible individuals who because of their disability need monitoring to assure their continued health and safety.
Supported Employment Services
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.
Third Party Payer
An insurance company, Medicare, Medicaid, governmental entity, health maintenance organization (HMO), special education, court, or other resource which is responsible for payment of services.
Transition Coordination
Assists an individual to procure one-time moving costs and/or arrange for all non-Medicaid services necessary to assist the individual with the actual coordination and implementation of their individualized plan to move back to the community.
Transitional Living (TL) Service
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.
Traumatic Brain Injured Residential Care Service
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.
Vulnerable Adult
An adult who has substantial mental or functional impairment.
Vulnerable Adult Protective Services (VAPS)
Addresses the safety of vulnerable adults who are at-risk of harm due to the presence or threat of abuse, neglect, or exploitation.
Vulnerable Adult Protective Services (VAPS) Report
Any person who reasonably believes that a vulnerable adult has been subjected to abuse or neglect or observes conditions or circumstances that reasonably would result in abuse or neglect must report the information to the department or to an appropriate law enforcement agency.
Willfully
Intentionally, knowingly, or recklessly.