Rural Differential Unit Rate for Qualified Service Providers 650-25-45-45

(NEW 7/1/19 ML #3552)

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Purpose:

The purpose of the rural differential rate is to create greater access to home and community-based services for caregivers who reside in rural areas of North Dakota by offering a higher rate to Qualified Service Providers (QSPs) who are willing to travel to provide services. QSPs that are willing to travel at a minimum distance of 21 miles round trip to provide care to authorized individuals in rural areas will be reimbursed at a higher rate to provide respite care services for FCSP caregivers. Rural differential unit rates vary based on the round-trip mileage. 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:

Only enrolled agencies or individual QSPs authorized to provide FCSP services are eligible to receive the rural differential rate. Family members are not eligible to receive rural differential rate unless they enroll as a QSP with the NDFCSP.

 

Service Activities, Authorized:

The rural differential rate is based on the physical address of the eligible caregiver and must be identified on the Caregiver Option Plan (SFN 165). The FCSP Rural Differential Rate Authorization (SFN 225) will be completed upon enrollment for each caregiver and QSP provider who meet the eligibility criteria for the rural differential rate. The SFN 225 will be completed upon closure to include the date of case closure.

 

Copies of the FCSP Rural Differential Rate Authorization when both opening and closing a case will be distributed as follows:

• Original to the QSP
• Copy to the caregiver file
• Copy to the Qualified Service Provider file
• Copy to the NDFCSP Program Administrator
• NDFCSP Program Administrator will forward a copy to Medical Services

The rural differential rate will be added on the FCSP Caregiver Option Plan as providers become eligible for the rate.

 

Service Eligibility:

The rural differential rate is caregiver specific. A FCSP caregiver receiving services paid at the rural differential rates will meet the following criteria:

1. Must be eligible for NDFCSP services.
2. Reside outside the city limits of Fargo, Bismarck, Grand Forks, Minot, West Fargo, Mandan, Dickinson, Jamestown, and Williston.
3. Needs respite care services and does not have access to a QSP of their choice, within a minimum of a 21-mile round trip distance of their residence who is willing to provide care.

The distance between the caregiver’s home and the QSPs home base must be verified by using the following website: www.mapquest.com. The most reasonable route must be used. A printed copy of the MapQuest results must be kept in the caregiver file. A copy of the MapQuest mileage verification must be sent with the SFN 225 to the NDFCSP Program Administrator.

 

If there is a discrepancy in what is considered city limits, notify the NDFCSP Program Administrator. The Rural Differential Program Administrator, Medical Services Division, will make the final determination.

 

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 FCSP caregiver.

• 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 caregiver’s home the rural differential rate may be used. If the employee lives less than 21 miles (round trip) from the caregiver’s home than the rural differential may not be used. Rural differential unit rates vary based on the number of round-trip mileage.
• Rural differential rates are based on the distance it takes to travel to each individual caregiver’s home even if the QSPs serve more than one caregiver in the community or in the same home.
• Information on the rural differential unit rate will be provided as changes occur.

 

Addresses:

The physical address (PO BOX is not acceptable) listed on the QSP list or NDFCSP Provider Agreement must be used when determining which rural differential rate to use for individual QSPs and Agency providers.