N.D. Admin. Code 75-02-02-13.2

Current through Supplement No. 395, January, 2025

Section 75-02-02-13.2 - Travel expenses for medical purposes - Individuals in an institution - Limitations

1. For purposes of this section:

a. "Long-term care facility" means a nursing facility, intermediate care facility for individuals with intellectual disabilities, or swing-bed facility; and

b. "Medical center city" means Bismarck, Devils Lake, Dickinson, Fargo, Grand Forks, Jamestown, Minot, and Williston, and includes any city that shares a common boundary with any of those cities.

2. A long-term care facility may not charge a resident for the cost of travel provided by the facility. Except as provided in subsection 4, a long-term care facility shall provide transportation to and from any provider of necessary medical services located within, or at no greater distance than the distance to, the nearest medical center city. Distance must be calculated by road miles.

3. If the resident has to travel farther than the nearest medical center city, the costs of travel may be reimbursed by Medicaid according to the appropriate fee schedule. Distance must be calculated by map miles.

4. A long-term care facility is not required to pay for transportation by ambulance for emergency or nonemergency situations for residents.

5. A service provider that is paid a rate, determined by the department on a cost basis that includes transportation service expenses, however denominated, may not be compensated as a transportation service provider for transportation services provided to an individual residing in the provider's facility. The following service providers may not be so compensated:

a. Basic care facilities;

b. Residential habilitation services for individuals with intellectual or developmental disabilities;

c. Intermediate care facilities for individuals with intellectual disabilities;

d. Independent habilitation services for individuals with intellectual or developmental disabilities;

e. Nursing facilities;

f. Psychiatric residential treatment facilities;

g. Qualified residential treatment programs; and

h. Swing-bed facilities.

6. If, under the circumstances, a long-term care facility is not required to transport a resident, and the facility does not actually transport the resident, the availability of transportation services and payment of travel expenses is governed by section 75-02-02-13.1.

N.D. Admin Code 75-02-02-13.2

Effective July 1, 1996; amended effective July 1, 2012; October 1, 2012.

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

Amended by Administrative Rules Supplement 368, April 2018, effective 4/1/2018.

Amended by Administrative Rules Supplement 376, April 2020, effective 4/1/2020.

Amended by Administrative Rules Supplement 2023-391, January 2024, effective 1/1/2024.

General Authority: NDCC 50-24.1-04

Law Implemented: NDCC 50-24.1-04