N.D. Admin. Code § 33-07-01.1-01 – General Provisions - Definitions

33-07-01.1-01. General provisions - Definitions.

1. Institutions covered by medical hospital licensure laws. The following types of institutions are covered by North Dakota Century Code chapter 23-16 for the purpose of rules and are deemed to come within the provisions of North Dakota Century Code section 23-16-01 which provides for licensure of any institution that maintains and operates organized facilities for the diagnosis, treatment, or care of two or more nonrelated individuals suffering from illness, injury, or deformity or where obstetrical or other care is rendered over a period exceeding twenty-four hours:

a. General acute, primary care, and specialized hospitals, including rehabilitation, psychiatric, and outpatient birth hospitals.

b. Skilled nursing facilities and nursing facilities.
c. Outpatient facilities, including surgical centers and trauma centers, excluding physicians' clinics.
d. Maternity homes that receive more than one patient in six months.2. Institutions not covered by medical hospital licensure laws. The following types of institutions that provide some medical or nursing service are deemed not to come within the provisions of North Dakota Century Code chapter 23-16:- a. American society of addiction medicine level 3.7 substance use treatment programs licensed by the department that are independent from a medical hospital.
b. Federal and state institutions. For state institutions, the primary purpose of which is the provision of medical care, the department has the responsibility for inspection on the same basis as those institutions that are covered by North Dakota Century Code chapter 23-16. Upon the findings of such inspections, recommendations will be formulated by the department.
c. Chiropractic hospitals licensed under North Dakota Century Code chapter 23-17.
d. Homes in which the only individuals receiving nursing care are those related to the householder by blood or marriage.
e. Homes in which only one individual receives care at any one time.3. An institution shall hold licensure in the same category for which it seeks federal certification.4. The following terms are defined for purposes of this chapter and North Dakota Century Code chapter 23-16:- a. 'Abuse' includes mental, physical, sexual, and verbal abuse which would result in temporary or permanent mental or physical injury, harm, or ultimately death. Mental abuse includes humiliation, harassment, threats of punishment, or deprivation. Physical abuse includes hitting, slapping, pinching, and kicking. It also includes controlling behavior through corporal punishment. Sexual abuse includes sexual harassment, sexual coercion, sexual contact, or sexual assault. Verbal abuse includes any use of oral, written, or gestured language that includes disparaging and derogatory terms to patients or their families used within their hearing distance to describe the patients, regardless of their age, ability to comprehend, or disability.
b. 'Acute care' means care for an episode of illness, injury, deformity, or pregnancy which may have a rapid onset or be severe in nature or have a short duration which requires medical treatment and continuous nursing care in a hospital setting.
c. 'Authentication' means identification of the individual who made the medical record entry by that individual in writing, and verification that the contents are what the individual intended.
d. 'Bed capacity' is bed space designed for inpatient care.- (1) Areas to be included:
(a) Bed space in all nursing units, including:
1. [1] Intensive care or cardiac care units.
[2] Minimal or self-care units.
(b) Isolation units.
(c) Pediatrics units, including:
[1] Pediatric bassinets.
[2] Incubators located in the pediatrics department.
(2) Areas to be excluded:
(a) Newborn nurseries in the obstetrical department.
(b) Labor and delivery rooms.
(c) Recovery rooms.
(d) Emergency units.
(e) Preparation or anesthesia induction rooms.
(f) Rooms designed for diagnostic or treatment procedures.
(g) Hospital staff sleeping quarters, including accommodations for oncall staff.
e. 'Department' means the North Dakota department of health and human services.
f. 'Governing body' means the individual or group in whom the ultimate authority and legal responsibility is vested for the conduct of the institution.
g. 'Hospital' means a facility that provides continuous nursing services, the principal activity or business of which is the reception of an individual for diagnosis, medical care, and treatment of human illness to meet the needs of the patient served.
(1) 'General acute hospital' means a facility with physician services available, permanent facilities that include inpatient beds, and continuous registered nurse staffing on a twenty-four-hour basis for treatment or care for illness, injury, deformity, abnormality, or pregnancy.
1. (a) In addition to medical staff and nursing services, the hospital shall regularly maintain either directly or through agreement the following services to meet the needs of the patients served:
2. [1] Dietary services.
3. [2] Medical records services.
4. [3] Pharmaceutical services.
5. [4] Laboratory services.
6. [5] Radiology services.
7. [6] Emergency services.
8. [7] Social services.
9. [8] Basic rehabilitation services.

[9] Housekeeping and related services including laundry. [10] Central services. (b) Complementary services are optional services that the hospital may provide and include: [1] Nuclear medicine services. [2] Surgical services. [3] Recovery services. [4] Anesthesia services. [5] Respiratory care services. [6] Obstetrical services. [7] Specialized rehabilitation services. [8] Psychiatric services. [9] Outpatient birth services. (2) "Primary care hospital" means a facility that has available twenty-four-hour licensed health care practitioner and nursing services, provides inpatient care to ill or injured individuals prior to their transportation to a general acute hospital, or provides inpatient care to individuals needing acute-type care for a period of no longer than an average of ninety-six hours, excluding individuals participating in a federal swing-bed program. (a) In addition to medical staff and nursing services, the hospital shall regularly maintain either directly or through agreement the following services to meet the needs of the patients served: [1] Dietary services. [2] Medical records services. [3] Pharmaceutical services. [4] Laboratory services. [5] Radiology services. [6] Emergency services. [7] Social services. [8] Basic rehabilitation services. [9] Housekeeping and related services including laundry. [10] Central services. (b) Complementary services are optional services which the hospital may provide and include: [1] Nuclear medicine services.

[2] Surgical services. [3] Recovery services. [4] Anesthesia services. [5] Respiratory care services. [6] Obstetrical services.

(3) "Specialized hospital" means a facility with hospital characteristics which provides medical care for individuals with a categorical illness or condition.

(a) In addition to medical staff and nursing services, the hospital shall regularly provide directly or through agreement the following services to meet the needs of the patients served: [1] Dietary services. [2] Medical records services. [3] Pharmaceutical services. [4] Laboratory services. [5] Radiology services. [6] Emergency services. [7] Social services. [8] Basic rehabilitation services. [9] Housekeeping and related services including laundry. [10] Central services.

(b) Complementary services are optional services which the hospital may provide and include: [1] Nuclear medicine services. [2] Surgical services. [3] Recovery services. [4] Anesthesia services. [5] Respiratory care services. [6] Obstetrical services.

(c) Hospitals meeting the definition of a specialized hospital shall be licensed as such and may include the following: [1] "Psychiatric hospital" means a facility or unit providing psychiatric services to patients with a diagnosis of mental illness. A psychiatric hospital is a hospital licensed to provide only psychiatric services or is a distinct unit providing only psychiatric services located in a general acute

hospital. Psychiatric hospitals must provide services consistent with section 33-07-01-36.

[2] "Rehabilitation hospital" means a facility or unit providing specialized rehabilitation services to patients for the alleviation or amelioration of the disabling effects of illness or injury. Specialized rehabilitation services are characterized by the coordinated delivery of interdisciplinary care intended to achieve the goals of maximizing the self-sufficiency of the patient. A rehabilitation hospital is a facility licensed to provide only specialized rehabilitation services or is a distinct unit providing only specialized rehabilitation services located in a general acute hospital. A rehabilitation hospital must arrange to provide the services identified in section 33-07-01-35.

[3] "Outpatient birth hospital" means a facility, separate from acute obstetric and newborn care, providing outpatient obstetrical, birthing, and neonatal services to patients. Outpatient birth services are organized to provide maternity care in which births are planned to occur in a setting away from the individual's usual residence following a low-risk pregnancy with anticipation of a low-risk birth. Low-risk pregnancy and birth means a normal uncomplicated birth as defined by generally accepted criteria of maternal and fetal health. A low-risk pregnancy and birth must be full term, singleton, and multipara, with vertex presentation.

[4] "Rural emergency hospital" means a facility that operates for the purpose of providing emergency department services, observation care, and other outpatient medical and health services in which the annual per-patient average length of stay does not exceed twenty-four hours. The facility may not provide inpatient services, except those furnished in a unit that is a distinct part licensed as a skilled nursing facility to furnish posthospital extended care services.

h. "Level I nursery" means a well newborn nursery, consistent with American academy of pediatrics standards, providing a basic level of care to neonates who are low risk.

i. "Level II nursery" means a special care nursery, consistent with American academy of pediatrics standards, for stable or moderately ill newborn infants who are born at greater than or equal to thirty-two weeks gestation or who weigh greater than or equal to one thousand five hundred grams at birth with problems that are expected to resolve rapidly and who would not be anticipated to need subspecialty-level services on an urgent basis.

j. "Level III nursery" means a neonatal intensive care unit, consistent with American academy of pediatrics standards, for infants who are born at less than thirty-two weeks gestation, weigh less than one thousand five hundred grams at birth, or have medical or surgical conditions.

k. "Licensed health care practitioner" means an individual who is licensed or certified to provide medical, medically related, or advanced registered nursing care to individuals in North Dakota.

l. "Licensee" means an individual, officer, or member of the governing body of a hospital or related institution.

m. "Medical staff" in general acute and specialized hospitals means a formal organization of physicians (and dentists) and may include other licensed health care practitioners with the delegated authority and responsibility to maintain proper standards of patient care

and to plan for continued improvement of that care. Medical staff in primary care hospitals means one or more licensed health care practitioners with the delegated authority and responsibility to maintain proper standards of medical care and to plan for continued improvement of that care.

n. 'Misappropriation of patient property' means the deliberate misplacement, exploitation, or wrongful temporary or permanent taking or use of a patient's belongings or money, or both.
o. 'Neglect' includes one severe incident or a pattern of incidents of willful failure to carry out patient services as directed or ordered by the licensed health care practitioner, willful failure to give proper attention to patients, or failure to carry out patient services through careless oversight.
p. 'Nursing facilities' are the following:
(1) 'Basic care facility' means a facility consistent with North Dakota Century Code chapter 23-09.3 and North Dakota Administrative Code chapter 33-03-24.
(2) 'Nursing facility' means a facility consistent with North Dakota Century Code chapter 23-16 and North Dakota Administrative Code chapters 33-07-03.1 and 33-07-04.1.
q. 'Outpatient facility' (including ambulatory surgical centers and trauma centers - excluding physicians' clinic) means a facility, located in or apart from a hospital; providing community service for the diagnosis or diagnosis and treatment of ambulatory patients (including ambulatory inpatients) in need of physical or mental care:
(1) Which is operated in connection with a hospital; or
(2) Which offers to patients not requiring hospitalization the services of licensed health care practitioners in various medical specialties, and which makes provision for its patients to receive a reasonably full range of diagnostic and treatment services.
r. 'Separate license for building on separate premises' means, in the case of a hospital or related institution where two or more buildings are used in the housing of patients, a separate license is required for each building. Separate licenses are required even though the buildings may be operated under the same management.
s. 'Signature' means the name of the individual written by the individual or an otherwise approved identification mechanism used by the individual which may include the approved use of a rubber stamp or an electronic signature.
t. 'Writing' means the use of any tangible medium for entries into the medical record, including ink or electronic or computer coding, unless otherwise specifically required.

History: Effective April 1, 1994; amended effective August 1, 1999; May 1, 2001; July 1, 2017; January 1, 2024.

Law Implemented: NDCC 23-16-06, 31-08-01.2, 31-08-01.3