Payment under the ex-SPED program

1. Payment for ex-SPED services may only be made to an enrolled qualified service provider who meets the standards described in chapter 75-03-23. 2. The department shall establish provider rates for home and community-based services in accordance with a procedure that factors in: a. Whether a provider is an individual or an agency; and b. The range of rates submitted by various providers. 3. The rate for a specific qualified service provider is established at the time the provider agreement is signed. 4. The department shall grant a request for a rate decrease when the department receives a written request for the decrease from the qualified service provider. 5. The department shall grant in full or in part, or shall deny, a request for a rate increase, when the department receives a written request for the rate increase from the qualified service provider. 6. The department shall determine the maximum amount allowable per eligible individual each month for a specific service. 7. The department shall establish the aggregate maximum amount allowable per eligible individual each month for all services. 8. The department may grant approval to exceed the monthly service program maximum for a specific eligible individual who is only receiving ex-SPED funds if: a. The eligible individual has a special or unique circumstance; and b. The need for additional service program funds will not initially exceed three months. Under emergency conditions, the department may grant a one-time extension not to exceed an additional three months. 9. The department shall notify the eligible individual of the department's determination regarding the request to exceed the monthly service program maximum. If the department denies the request to exceed the monthly aggregate maximum, the department shall inform the eligible individual in writing of the reason for the denial, the eligible individual's right to appeal, and the appeal process, as provided in chapter 75-01-03. 10. The department will grant approval to exceed the monthly program maximum or service maximum for eligible individuals receiving ex-SPED funds whose service units exceed the program caps as a result of the qualified service provider rate increase. This extension is limited to eligible individuals who were receiving services prior to July 1, 2007.