ModifiedNorth Dakota Department of Health & Human ServicesPolicy 33-03-24.1

Basic Care Facilities

Customize your policy alerts

Sign up for North Dakota Department of Health & Human Services Policy 33-03-24.1 alerts

Get alerted when Policy 33-03-24.1 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Governs the licensure, administration, resident services, records, staffing, education, assessments, and enforcement of North Dakota basic care facilities serving five or more unrelated residents on a 24-hour basis.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyBasic Care Facilities

Policy CodePolicy 33-03-24.1

Change TypeModified

Effective DateJuly 1, 2020

Next Review DateNot specified

Key ActionSubmit a plan of correction within ten days after receiving notification of deficiencies.

SourceLink

POLICY UPDATE CHANGES

End-of-life service requirements were amended effective July 1, 2020.

The general building requirements section was repealed effective July 1, 2015.

5+Minimum unrelated residents

14 daysInitial assessment deadline

21 daysCare plan deadline

5 yearsResident record retention

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

ModifiedNorth Dakota Department of Health & Human ServicesPolicy 33-03-24.1

Basic Care Facilities

Customize your policy alerts

Sign up for North Dakota Department of Health & Human Services Policy 33-03-24.1 alerts

Get alerted when Policy 33-03-24.1 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyBasic Care Facilities

Policy CodePolicy 33-03-24.1

Change TypeModified

Effective DateJuly 1, 2020

Next Review DateNot specified

Key ActionSubmit a plan of correction within ten days after receiving notification of deficiencies.

SourceLink

POLICY UPDATE CHANGES

End-of-life service requirements were amended effective July 1, 2020.

The general building requirements section was repealed effective July 1, 2015.

5+Minimum unrelated residents

14 daysInitial assessment deadline

21 daysCare plan deadline

5 yearsResident record retention

Facility Service and Operating Requirements

General basic care facility operating requirements

Basic care facilities must meet all of the following operating requirements:

ALL of the following

ALL of the following
- Complete a written resident assessment within 14 days of admission and thereafter at least quarterly, or more often as determined by an appropriately licensed professional. The assessment must address health, psychosocial, functional, nutritional, activity, personal care, health needs, self-preservation capability, and social and activity interests.
ALL of the following
- Develop a resident care plan within 21 days of admission based on the assessment and resident or legal representative input; implement it consistently and update it as needed, at least quarterly.
ALL of the following
- Securely maintain resident records, including assessments, care plans, progress notes, medication records, transfer and discharge documentation, and required safety documentation, for at least five years after discharge or death.
ALL of the following
- Provide resident-centered personal care, medication assistance and controls, social services, nursing services, dietary services, meaningful activities, and safe, clean, sanitary housekeeping and laundry services.

Adult day care services

Adult day care services may be provided only when all of the following requirements are met:

ALL of the following

Obtain department approval before providing adult day care services.
Use existing facility space and equipment only if doing so does not diminish services provided to facility residents or prevent their needs from being met.
Administer medications and treatments only pursuant to the order of a licensed health care practitioner.
Maintain records of services provided to adult day care participants.
Provide a private area where adult day care participants may rest.

End-of-life care

Facilities retaining residents who require end-of-life care remain responsible for all resident care and must meet all of the following requirements:

ALL of the following

Retain only a resident who chooses to remain in the facility and requires more than intermittent nursing care; do not admit an individual who requires skilled nursing care or is not capable of self-preservation.
Employ or contract with a registered nurse to supervise resident care and employ a licensed nurse to identify and respond to needs, develop and oversee the care plan, and review and document individual needs and care provided.
Develop and implement an interdisciplinary care plan, in consultation with the resident or designee, that identifies how needs will be met, delineates the roles of facility staff and others, lists end-of-life medications, and identifies who is authorized to administer them.
Complete facility evacuation or E-score reviews after a significant change in the resident's self-evacuation capability, adjust staffing consistent with the E scores, and maintain a slow evacuation capability.

Optional specialized memory care and traumatic brain injury services

Facilities or units providing Alzheimer's, dementia, special memory care, or traumatic brain injury services must meet all of the following requirements:

ALL of the following

Submit the required application, obtain written department approval, comply with the specialized-service requirements, and obtain approval on a printed new license before providing or advertising these services.
Admit or retain only residents who meet the basic care functional level of care and are capable of self-preservation; specialized residents may require dedicated personal care staff 24 hours per day but may not need more than intermittent nursing or medical care.
Provide dedicated personal care, intermittent licensed nursing oversight, protective supervision in a structured and sufficiently staffed setting, assistance with activities of daily living and instrumental activities of daily living, therapeutic, social, and recreational programming, and care that fosters or improves resident independence.
Provide resident-rights protections addressing privacy, dignity, respect, autonomy, independence, freedom from coercion and restraint, choice of roommate, control of schedules and activities, visitor access, community access, and outdoor access, including secured outdoor space for residents of secured facilities or units.

Key Thresholds and Timeframes

Basic care facility threshold

Minimum residentsFive or more residents

Resident relationshipResidents must not be related by blood or marriage to the owner or manager

Facility typeBasic care facility

End-of-life care threshold

Prognosis thresholdSix or fewer months to live

Care typePalliative and supportive care

Required documentationA licensed health care practitioner's order identifying a terminal illness or condition

Facility Compliance Responsibilities

Prior Authorization

Obtain and Renew Facility Licensure

Obtain a department license before operating a basic care facility, before a change in ownership, annually, and whenever the department determines the facility meets the basic care facility definition. Renewal applications must be received with sufficient processing time before the licensure period begins.

An initial license may be valid for no more than one year and expires December 31 of the year issued.
Licenses are issued by calendar year and expire December 31.
A provisional license may be issued for up to three months when noncompliance does not endanger residents; it may be renewed once for up to an additional three months if an acceptable plan of correction is approved but compliance is not yet achieved.
Display the license conspicuously. The license is not transferable and is valid only for the premises for which it was issued.

Prior Authorization

Submit Floor Plans Before Opening or Alteration

Submit floor plans to the department for review and approval before opening a facility or making structural alterations, including alterations that increase or decrease resident bed capacity.

Defined Terms

Abuse

DefinitionWillful infliction of mental, physical, sexual, or verbal abuse

Potential harmConduct that could result in temporary or permanent mental, physical, emotional, or psychological injury or harm

Covered formsMental, physical, sexual, and verbal abuse

Activities of daily living

DefinitionPersonal and functional activities required for continued well-being

ExamplesEating, nutrition, dressing, personal hygiene, mobility, toileting, and behavior management

Purpose

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyBasic Care Facilities

Policy CodePolicy 33-03-24.1

Change TypeModified

Effective DateJuly 1, 2020

Next Review DateNot specified

Key ActionSubmit a plan of correction within ten days after receiving notification of deficiencies.

SourceLink

On This Page

Ensure nursing and personal care staff complete training and competency evaluation specific to end-of-life care before providing care; ensure appropriate training and competency for family members, volunteers, or designees who provide care.

Promptly arrange discharge or transfer to a safe and appropriate location consistent with the level of care required if the facility cannot meet the resident's needs or comply with the end-of-life requirements.

Develop a person-centered care plan after the functional assessment based on input from the resident or designee; review it at least quarterly and whenever the resident's needs change, and modify it as needed.

Ensure nursing and personal care staff complete at least 8 educational hours within 3 months of hire, successfully complete competency evaluation before working independently, receive at least 4 hours of annual training in two or more designated topics, and complete annual competency evaluation.

Promptly arrange discharge or transfer to a safe and appropriate placement consistent with the required level of care if the facility or unit cannot meet the resident's needs or the resident no longer meets retention criteria.

Significant medication error

Pattern thresholdMore than three medication errors

Potential consequencePotential for causing a negative impact or harm to residents

Individual error standardAn error that causes resident discomfort or jeopardizes health and safety

Provisional license

Initial durationNot to exceed three months from the date of issuance

Renewal limitMay be renewed no more than one time

Renewal durationUp to an additional three months

Plan of correction

Submission deadlineWithin ten days

Deadline beginsUpon receipt of the notification of deficiencies

Required submissionA plan of correction

Deficiency correction

Correction deadlineWithin sixty days of the survey completion date

Alternative schedulePermitted if approved by the department

ScopeCorrection of deficiencies

Enforcement action

Standard effective dateNinety days from the date of written notice

NoticeThe department must notify the facility in writing of its decision to initiate enforcement

ExceptionThe department determines there is imminent danger to residents

Enforcement review

Request deadlineWithin forty-five days

Deadline beginsThe date the department notifies the facility in writing of its decision to initiate enforcement

Review purposeTo verify correction of deficient practices

Reconsideration

Request deadlineWithin ten days

Deadline beginsThe date the department notifies the facility in writing of its decision to initiate enforcement

Request typeWritten request for reconsideration

Appeal

Appeal deadlineBy 5:00 p.m. on the fortieth day

Deadline beginsThe date the department notifies the facility in writing of its decision to initiate enforcement

Eligible decisionA qualifying decision on a request for reconsideration

Administrator education

Annual requirementAt least twelve continuing education hours per year

Required participantThe administrator

Subject matterCare and services for residents

Dietary staff education

Annual frequencyAt least two educational programs per year

Required staffStaff responsible for food preparation

Program typeDietary educational programs

Activities staff education

Annual frequencyAt least two educational programs per year

Required staffStaff responsible for activities

Program typeActivity-related educational programs

Resident assessment

Initial assessmentWithin fourteen days of admission

Subsequent frequencyAt least quarterly thereafter

Completion requirementThe assessment must be completed in writing by an appropriately licensed professional

Resident care plan

Initial care planWithin twenty-one days of the admission date

Update frequencyAs needed, but no less than quarterly

BasisThe assessment and input from the resident or person with legal status to act on the resident's behalf

Resident records

Retention periodNot less than five years

Retention beginsFrom the date of discharge or death

Records coveredAll resident records

Initial assessment

Initial assessment deadlineWithin 14 days of admission

Required professionalAn appropriately licensed professional

DocumentationThe assessment must be completed in writing

Admission care plan

Admission care plan deadlineWithin 21 days of admission

Plan basisThe resident assessment and input from the resident or legal representative

ImplementationThe plan must be consistently implemented in response to individual resident needs and strengths

Assessment and care plan review

Review frequencyAt least quarterly

Specialized-plan reviewAlso upon a change in resident need

Update standardPlans must be modified or updated as needed

Resident records

Retention periodAt least 5 years

Retention beginsFrom discharge or death

Storage requirementResident records must be securely maintained and stored

Meals

Daily minimumAt least 3 meals each day

Meal standardMeals must be nutritious and well-balanced

Dietary basisRecommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences

Meal interval

Maximum intervalNo more than 14 hours

Interval measuredBetween an evening meal and breakfast

Dietary serviceThe facility must meet residents' dietary needs

Fire drill documentation

Documentation deadlineWithin 5 days of admission

Required documentationA fire drill walk-through

Record locationResident records must include the documentation

Medication regimen review

Minimum frequencyAt least annually

Additional reviewAs needed

ReviewerThe resident's licensed health care practitioner, another applicable licensed health professional, or a consulting pharmacist

Food menu retention

Retention periodAt least 3 months

Records retainedMenus of food served

Menu requirementMenus must be maintained by the facility

Specialized-care initial training

Initial trainingAt least 8 educational hours

Completion deadlineWithin 3 months from the date of hire

Work limitationStaff may not work independently until successfully completing a competency evaluation

Specialized-care annual training

Annual trainingAt least 4 educational hours annually

Topic breadthTraining must cover two or more designated topics

Annual competencyStaff must successfully complete an annual competency evaluation

Documentation Required

Cooperate With Department Inspections

Cooperate with department inspections and provide access to all materials and information the department determines are necessary to assess compliance. The department may inspect a facility at any time.

An initial-license inspection may result in issuance of an initial or provisional license or denial of the application.
Refusing to allow a department survey may result in enforcement action.

Prior Authorization

Request a Licensure Waiver

Request a waiver from the department when compliance with a licensure requirement would create an unreasonable hardship, provided the waiver is limited to a specified period and noncompliance would not adversely affect residents' health or safety.

Documentation Required

Submit a Plan of Correction

Submit a plan of correction within ten days after receiving a deficiency notification. The plan must explain how each deficiency will be corrected, how continued compliance will be assured, and when corrective action will be completed.

Complete corrections within sixty days after the survey, unless the department approves an alternative schedule.
The department may accept, reject, modify, or direct the plan and may verify correction by telephone, mail, or onsite revisit.
Failure to submit an acceptable plan or correct deficiencies may result in enforcement action.

Denial Risk

Avoid Enforcement Action

Avoid conditions that may trigger a ban or limitation on admissions, license suspension or revocation, or denial of licensure. Enforcement may apply for serious or recurring noncompliance, refusal of a survey, misconduct, or licensing fraud.

Triggers include imminent danger; a direct or immediate negative relationship to resident health, safety, or security; or potential jeopardy if deficiencies remain uncorrected.
Other triggers include recurrence of the same or substantially similar deficient practice within 36 months, failure to follow an approved plan, gross incompetence, negligence, misconduct, fraud, deceit, misrepresentation, bribery, or aiding improper licensure.
An enforcement action generally takes effect 90 days after written notice unless the department determines there is imminent danger.
The facility may request department review to verify correction within 45 days of written notice and must submit supporting documentation; review and any revisit must occur within 60 days.

Note

Use Reconsideration and Appeal Procedures

Use the department's reconsideration and appeal procedures for qualifying enforcement decisions, while recognizing that a reconsideration request does not delay implementation of the enforcement action.

File a written reconsideration request within 10 days after written notice of the decision to initiate enforcement action.
Include the department notice, the factual basis for each disputed deficiency, the statutes or rules relied upon, and the contact information for receipt of notices.
The department must grant or deny reconsideration within 10 days; if undertaken, it must decide reconsideration within 20 days of receipt.
A request must specifically identify each disputed deficient practice and may not rely on correction of the deficiency as the basis for reconsideration.
A qualifying appeal must be mailed or delivered to the department by 5:00 p.m. on the 40th day after notice of the department's decision to initiate enforcement action and must include the reconsideration decision notice, disputed practices and factual bases, relied-upon authority, and notice-contact information.
An appeal addresses whether the deficient practice occurred, not whether it was later corrected.

Documentation Required

Maintain Governing-Body Policies

Maintain written governing-body policies and procedures for resident services and facility operations. Policies must be approved, signed, dated, reviewed annually, and revised as needed.

Address services including admission, transfer, discharge, discharge planning, and referrals; emergency and serious-condition protocols; pharmacy and medication services; infection control; abuse, neglect, and misappropriation; significant medication-error reporting; complaints; resident rights; and personnel practices.
Personnel records must include job descriptions, applicable credential verification, and training and education records.
Ensure applicable clinical laboratory improvement requirements are met when laboratory testing is provided.
Appoint an administrator and designate in writing an onsite responsible staff member for the administrator's absence; maintain sufficient trained and competent staff onsite, awake, and prepared to assist residents 24 hours a day.

Unsupported block type: documentation

Unsupported block type: prior_auth

Prior Authorization

Submit the End-of-Life Service Application

When retaining residents who require end-of-life care, apply on the basic care application form and indicate the change in services provided.

The facility remains responsible for all resident care and services and must comply with the end-of-life requirements.
Employ or contract with a registered nurse to supervise care and ensure licensed-nurse assessment, care planning, oversight, and documentation.
A facility, resident, or designee may contract with a person or hospice agency to meet the resident's needs.

Unsupported block type: prior_auth

Unsupported block type: info

Unsupported block type: denial_risk

Denial Risk

Arrange End-of-Life Discharge or Transfer

Promptly arrange discharge or transfer to a safe and appropriate location consistent with the required level of care when the facility cannot meet the needs of a resident receiving end-of-life care or cannot comply with the end-of-life requirements.

Develop and implement an interdisciplinary care plan identifying how needs will be met, staff and outside-provider roles, end-of-life medications, and authorized medication administrators.
Ensure required nursing and personal-care staff training and competency evaluation is completed before caring for a terminally ill resident.

Denial Risk

Arrange Specialized-Care Discharge or Transfer

Promptly arrange discharge or transfer to a safe and appropriate placement consistent with the required level of care when the facility cannot meet a specialized-care resident's needs or the resident no longer meets the retention criteria.

Reassess whether the resident continues to meet the basic care functional level and self-preservation requirements.
Do not retain or continue specialized services when eligibility criteria are no longer met.

Documentation Required

Control Medication Administration

Administer and document medications in accordance with state law, applicable rules, and practice acts, and complete required medication storage and regimen reviews.

Keep staff-administered or supervised medications in original containers labeled consistently with state law and properly record administration at the time it occurs.
Provide secure medication storage and a key-accountability system; provide secure storage for residents who self-administer.
Ensure a licensed practitioner, qualified licensed professional, or consulting pharmacist reviews each resident's medication regimen as needed and at least annually.
A medication record is not required only when a licensed health care professional authorizes a resident to keep medications in the room and independently take the correct dose at the proper times.

Activities required by an individual for continued well-being

Assistance

Resident abilityAble to help with most of an activity but cannot do it entirely alone

Permitted supportPrompting or encouragement

Hands-on supportMinimal hands-on assistance from the personal care attendant

Independent

DefinitionThe resident can perform activities of daily living without help

Activities coveredActivities of daily living

Assistance requiredNone

Activity staff

RoleEmployee responsible for providing an activity program

Employment statusEmployee of the facility

Primary responsibilityProviding an activity program

Adult day care services

DefinitionProvision of basic care facility services

RecipientsIndividuals whose needs are being met by the services

Overnight stayIndividuals do not remain in the facility overnight

Basic care facility

LicensureA facility licensed by the department under North Dakota Century Code chapter 23-09.3

Residents servedFive or more residents not related by blood or marriage to the owner or manager

ServicesRoom and board and health, social, and personal care provided on a twenty-four-hour basis

Self-preservation

DefinitionAbility, with or without assistance, to evacuate the facility or relocate to a point of safety

EmergencyIn case of fire

StandardIn compliance with the requirements of this chapter

Department

DefinitionThe North Dakota state department of health

JurisdictionNorth Dakota

Entity typeState department of health

End-of-life care

DefinitionA program of palliative and supportive care

Required orderA licensed health care practitioner's order identifying a terminal illness or condition

PrognosisSix or fewer months to live

Facility

DefinitionA basic care facility

Facility classificationBasic care facility

Term usageFacility means a basic care facility

Governing body

DefinitionThe entity legally responsible for operation of a basic care facility

Legal responsibilityOperation of the basic care facility

Facility coveredA basic care facility

Instrumental activities of daily living

Household activitiesPreparing meals, shopping, managing money, housework, and laundry

Communication and transportationTransportation and use of telephone

Community mobilityMobility outside the basic care facility

Licensed health care practitioner

DefinitionAn individual licensed or certified to provide care

Care typesMedical, medically related, or advanced registered nursing care

Geographic requirementCare provided to individuals in North Dakota

Medication administration

DefinitionAn act in which a drug or biological is given to a resident

Authorized individualAn individual authorized under state laws and regulations

ExamplesLicensed health care practitioner, licensed nurse, or medication assistant

Misappropriation of resident property

DefinitionDeliberate misplacement, exploitation, or wrongful taking or use of a resident's belongings or money

DurationTemporary or permanent

Property coveredResident belongings, money, or both

Neglect

DefinitionFailure to carry out resident services as directed or ordered

Authorized directionDirection or orders from a licensed health care practitioner or other authorized personnel

Additional failureFailure to give proper attention to residents

Personal care

Daily living supportAssistance with activities of daily living

Instrumental supportAssistance with instrumental activities of daily living

SupervisionGeneral supervision of physical or mental well-being

Resident

DefinitionAn individual admitted and retained in a facility to receive room and board and health, social, and personal care

Safety capabilityThe individual is capable of self-preservation

Care limitationThe individual's condition does not require continuous, twenty-four-hour-a-day onsite nursing or medical care

Restricting device

DefinitionAny device that limits a resident from freely exiting the facility or unit

Included devicePressure devices that delay the time frame in which a door will open

EffectLimits free exit from the facility or unit

Secured facility

Facility typeAn Alzheimer's, dementia, or special memory care facility

Physical featureHas restricting devices

PurposeRestricts residents from freely exiting the building

Secured unit

AreaA specific Alzheimer's, dementia, or special memory care area

SeparationA restricting device separates the unit from residents in the remainder of the facility

Facility relationshipThe unit is within the facility

Significant medication error

Individual errorA medication error that causes resident discomfort or jeopardizes health and safety

Pattern thresholdMore than three medication errors

Pattern consequencePotential for causing a negative impact or harm to residents

Unsecured facility

Facility typeAn Alzheimer's, dementia, or special memory care facility

Restricting devicesWithout restricting devices

Exit conditionResidents are not prevented from freely exiting the building

Unsecured unit

AreaA specific Alzheimer's, dementia, or special memory care area

LocationSeparate from residents in the remainder of the facility

Restricting deviceThe area is without a restricting device