N.D. Admin. Code 75-03-23-02

Current through Supplement No. 394, October, 2024

Section 75-03-23-02 - Eligibility criteria

1. An applicant must be entered in the SPED program pool before service payments may be authorized. The department shall allow entry into the SPED program pool to occur:

a. When the department's designee submits a form in the manner prescribed by the department; or

b. When the applicant meets the special circumstances provided in subsection 4, 5, or 6 of section 75-03-23-03.

2. An applicant's resources may not exceed fifty thousand dollars for the applicant to be eligible for services under the SPED program. For purposes of this section, resources are cash or similar assets, except recovery rebates authorized by section 2201 of the federal Coronavirus Aid, Relief, and Economic Security Act of 2020 [ Pub. L. 116-136 ], that can be readily converted to cash and include residences owned by the applicant other than the applicant's primary residence.

3. An applicant eighteen years of age or older is eligible for the SPED program pool if:

a. The applicant has a functional impairment as specified by the department in policies and procedures to indicate applicant eligibility;

b. The applicant's functional impairment has lasted, or can be expected to last, three months or longer;

c. The applicant's functional impairment is not the result of a mental illness or a condition of mental retardation, or a closely related condition;

d. The applicant is living in North Dakota in a housing arrangement commonly considered a private residence and not in an institution;

e. The applicant is not eligible for services under the Medicaid waiver program or the Medicaid state plan option of personal care services unless the applicant's estimated monthly benefits under this chapter, excluding the cost of case management, are between the current medically needy income level for a household of one plus the disregard established in North Dakota Century Code section 50-24.1-02.3, and the lowest level of the fee schedule for services under North Dakota Century Code chapter 50-06.2, or unless the individual is receiving a service that is not available under Medicaid or the Medicaid waiver;

f. The applicant would receive one or more of the covered services under department policies and procedures for the specific service;

g. The applicant agrees to the plan of care developed for the provision of home and community-based services;

h. The applicant is not responsible for one hundred percent of the cost of the covered service provided, under the SPED program sliding fee scales based on family size and income; and

i. The applicant has not made a disqualifying transfer of assets.

4. An applicant under eighteen years of age is eligible for the SPED program pool if the applicant is determined to need nursing facility level of care as provided for in section 75-02-02-09 and the applicant's care need is not the result of a mental illness or the condition of mental retardation, or a closely related condition.

5. An applicant under eighteen years of age:

a. Must meet the eligibility requirements of subsections 3 and 4.

b. Is not eligible to receive personal care services under this chapter.

c. Is not eligible for service payments unless:

(1) Care provided to the applicant by the applicant's parent or the applicant's spouse is provided under family home care.

(2) The applicant is unable to regularly attend school or is severely limited in the amount of time the applicant is able to attend school.

6. An applicant must be capable of directing self-care or must have a legally responsible party to act on the applicant's behalf.

7. An applicant is not eligible for service payments if the care provided is court-ordered.

8. An applicant is eligible to receive covered services reimbursed under North Dakota Century Code chapter 50-06.2 or this chapter even if the applicant has natural supports.

N.D. Admin Code 75-03-23-02

Effective June 1, 1995; amended effective January 1, 2009.

Amended by Administrative Rules Supplement 2014-354, October 2014, effective 10/1/2014. .

Amended by Administrative Rules Supplement 2016-360, April 2016, effective 4/1/2016.

Amended by Administrative Rules Supplement 367, January 2018, effective 1/1/2018.

Amended by Administrative Rules Supplement 2020-378, October 2020, effective 5/19/2020.

Amended by Administrative Rules Supplement 2021-383, January 2022, effective 1/1/2022.

General Authority: ND CC 50-06.2-03(6)

Law Implemented: ND CC 50-06.2-01(3), 50-06.2-03(5), 50-06.2-04(3)