Rural Differential Rates 525-05-38

(Revised 1/1/14 ML #3399)

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Purpose

The purpose of the rural differential rate is to create greater access to home and community based services for clients who reside in rural areas of North Dakota by offering a higher rate to QSPs who are willing to travel to provide services. QSPs that are willing to travel at least 21 miles round trip to provide care to authorized individuals in rural areas will be reimbursed at a higher rate for those cares. QSPs are not paid for the time they drive to or from the client’s home; the rural differential rate may only be used for the time spent actually providing services.

Standards for Providers

Enrolled agency or individual QSPs, authorized to provide Respite Care, Homemaker, Personal Care, Nurse Education, Extended Personal Care, Chore Labor (does not include snow shoveling), or Transitional Living services.

Service Activities, Authorized

The rural differential rate must be identified on the Individual Care Plan (ICP) SFN 1467 and the Authorization to Provide Service SFN 1699. The SFN 1699 must be sent to the HCBS State office for all cases where the rural differential has been authorized. The ICP must also include the clients physical address (PO Box is not acceptable). A printed copy of the map quest results must be maintained in the clients file, and send into the HCBS State office.

Service Eligibility, Criteria for

An HCBS client receiving services paid at the rural differential rates will meet the following criteria:

1. Must be eligible for one of the following services: Medicaid Waiver, Service Payments to the Elderly & Physically Disable (SPED), Expanded Service Payments to the Elderly & Disabled (EX-SPED), Medicaid State Plan personal Care (MSP-PC).
2. Reside outside the city limits of Fargo, Bismarck, Grand Forks, Minot, West Fargo, Mandan, Dickinson, Jamestown, and Williston.

• Situations where there is a discrepancy in what is considered city limits must be prior approved by the Rural Differential Coordinator. The HCBS Case Manager must send a written request for verification to the HCBS Program Administer responsible for program oversight.

3. Needs any of the following services: respite care, homemaker, personal care, nurse education, extended personal care, chore labor (does not include snow shoveling), transitional living and does not have access to a QSP of their choice, within 21 miles of their residence, that is willing to provide care.

Service Delivery

The rural differential rate is based on the number of miles (round trip) a QSP travels from their home base to provide services at the home of an authorized HCBS recipient.

• Home base is either the individual QSPs physical address, or the Agencies home office, satellite office, or employees physical address (if they are not required to report to the home office each day because of distance) whichever is closer.
• If an agency employee is not required to report to the home office each day because of distance and they live 21 or more miles (round trip) from the client’s home the rural differential rate may be used. If the employee lives less than 21 miles (round trip) from the client’s home than the rural differential may not be used.
• Rural differential rates are based on the distance it takes to travel to each individual client’s home even if the QSPs serve more than one recipient in the community or in the same home.

Addresses:

Case Managers must use the physical address (PO BOX is not acceptable) listed on the QSP list when determining which rural differential rate to use for individual QSPs and Agency providers. A QSP list including the provider’s physical addresses will be provided to the HCBS Case Managers monthly.

Agency employees who are not required to report to their agency each day because of distance must make their address available to the HCBS office for verification. This address must be entered on the SFN 1699 under QSP physical address. If a QSP states that the physical address on the QSP list is incorrect they must contact the HCBS office to change it before an authorization can be provided that includes a rural differential rate. It is not sufficient to notify the case manager.

Determining Distance:

Case managers are required to verify distance between the HCBS client’s home and the QSPs home base by using the following website- www.mapquest.com. The Case Manager is responsible to choose the most reasonable route and print a copy of the MapQuest results that must be kept in the clients file.

• If there is a discrepancy, when calculating distance the final decision will be made by the Rural Differential Coordinator charged with program oversight. The HCBS Case Manager must send a written request explaining the issue to the Rural Differential Coordinator responsible for program oversight.