A nursing home is not eligible to receive medical assistance payments unless it refrains
from all of the following:
1.Charging private-paying residents rates for similar services which exceed those rates
which are approved by the department for medical assistance recipients, as
determined by the prospective desk audit rate, except under the following
circumstances: the nursing home may charge private-paying residents a higher rate
for a private room and charge for special services which are not included in the daily
rate if medical assistance residents are charged separately at the same rate for the
same services in addition to the daily rate paid by the department. Services covered
by the payment rate must be the same regardless of payment source. Special
services, if offered, must be of
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A nursing home is not eligible to receive medical assistance payments unless it refrains
from all of the following:
1. Charging private-paying residents rates for similar services which exceed those rates
which are approved by the department for medical assistance recipients, as
determined by the prospective desk audit rate, except under the following
circumstances: the nursing home may charge private-paying residents a higher rate
for a private room and charge for special services which are not included in the daily
rate if medical assistance residents are charged separately at the same rate for the
same services in addition to the daily rate paid by the department. Services covered
by the payment rate must be the same regardless of payment source. Special
services, if offered, must be offered to all residents and charged separately at the
same rate. Residents are free to select or decline special services. Special services
must not include services which must be provided by the nursing home in order to
comply with licensure or certification standards and that if not provided would result in
a deficiency or violation by the nursing home. Services beyond those required to
comply with licensure or certification standards must not be charged separately as a
special service if they were included in the payment rate for the previous reporting
year. A nursing home that charges a private-paying resident a rate in violation of this
chapter is subject to an action by the state or any of its subdivisions or agencies for
civil damages. A private-paying resident or the resident's legal representative has a
cause of action for civil damages against a nursing home that charges the resident
rates in violation of this chapter. The damages awarded shall include three times the
payments that result from the violation, together with costs and disbursements,
including reasonable attorney's fees or their equivalent.
2. Requiring an applicant for admission to the home, or the guardian or conservator of
the applicant, as a condition of admission, to pay any fee or deposit, loan any money
to the nursing home, or promise to leave all or part of the applicant's estate to the
home.
3. Requiring any resident of the nursing home to utilize a vendor of health care services
who is a licensed physician or pharmacist chosen by the nursing home.
4. Providing differential treatment on the basis of status with regard to public assistance.
5. Discriminating in admissions, services offered, or room assignment on the basis of
status with regard to public assistance. Admissions discrimination shall include, but is
not limited to:
a. Basing admissions decisions upon assurance by the applicant to the nursing
home, or the applicant's guardian or conservator, that the applicant is neither
eligible for nor will seek public assistance for payment of nursing home care
costs.
b. Engaging in preferential selection from waiting lists based on an applicant's ability
to pay privately.
The collection and use by a nursing home of financial information of any applicant
pursuant to a preadmission screening program does not raise an inference that the
nursing home is utilizing that information for any purpose prohibited by this chapter.
6. Requiring any vendor of medical care, who is reimbursed by medical assistance under
a separate fee schedule, to pay any portion of the vendor's fee to the nursing home
except as payment for the fair market value of renting or leasing space or equipment
of the nursing home or purchasing support services, if those agreements are disclosed
to the department.
7. Refusing, for more than twenty-four hours, to accept a resident returning to the
resident's same bed or a bed certified for the same level of care, in accordance with a
physician's order authorizing transfer, after receiving inpatient hospital services.
8. Violating any of the rights of health care facility residents enumerated in section
50-10.2-02.
9. Charging a managed care organization a rate that is less than the rate approved by
the department for a medical assistance recipient in the same classification.