Service Activities 650-25-45-30

(Revised 07/01/22 ML #3690)

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COVID-19 Service Standards

 

During the COVID-19 pandemic, FCSP caregivers may experience additional challenges specifically related to COVID such as a COVID diagnosis, exposure to the virus, quarantine, etc. With prior approval from the Aging Services Division Staff, and if it is determined the need is directly related to COVID-19, the following exceptions may apply:

  1. The requirement that the provider cannot reside in the same household as the care recipient may be waived.

  2. The requirement that FCSP respite cannot be used while the caregiver is at work may be waived.

  3. Personal Protective Equipment may be authorized as a supplemental services expense.

Access Assistance – Case management includes the following activities:

  1. Accept and respond to referrals to the program.

  2. Make home visits or arrange for visits in a location convenient for the caregiver.

  3. Complete individual caregiver assessments on all eligible caregivers using the web-based data collection system Caregiver Assessment Tool to determine need. Caregiver assessments must be updated on an annual basis and should be conducted face-to-face. Documentation must be present in the narrative section of the Caregiver Assessment Tool to indicate the reason the assessment was not updated.

  4. Using the Caregiver Assessment Tool, develop and implement an individualized Caregiver Option Plan (SFN 165) that addresses the needs unique to the caregiver. The plan must identify services to be received, the entity providing the service and the expected outcomes. The effective date on the Caregiver Option Plan (SFN 165) will not exceed the 12-month enrollment period.

  5. New Caregiver Option Plans (SFN 165) must be completed when the effective date expires. Caregiver Option Plan (SFN 165) updates may be completed by meeting with or making phone contact with caregivers and acquiring signatures as required by the Department. A copy of the Caregiver Option Plan shall be provided to the caregiver after each review date and if there were changes in services or providers.

  6. The Caregiver Option Plan (SFN 165) shall be reviewed every three months at a minimum to monitor service usage and assure caregiver goals and outcomes are being met.

  7. Conduct a minimum of one contact per quarter (one face-to-face and three telephone contacts) during the enrollment period; additional contacts may be conducted as needed

  8. A follow-up telephone call to the caregiver should be conducted within 30 days of enrollment.

  9. Completion of required Department forms needed to authorize services (i.e. SFN 135 North Dakota Family Caregiver Support Program Provider Service Log – Individual; SFN 492 North Dakota Family Caregiver Support Program Provider Service Log – Agency; SFN 549 Respite Home Evaluation; and SFN 225 NDFCSP Rural Differential Unit Rate Authorization).

  10. Create/maintain working partnerships with other agencies and organizations that provide services to support caregivers.

Counseling/Support Groups/Caregiver Training – Individual and Family

1. Counseling: Identify and arrange for payment for qualified professionals to complete up to four sessions during a 12-month enrollment period for individual or family counseling of eligible caregivers. If the caregiver has insurance that covers counseling, it should be the primary payor for counseling sessions to avoid duplication of service.

  1. If it can be demonstrated that the caregiver has an extraordinary need for additional counseling beyond the four sessions, a written request must be submitted to the NDFCSP Program Administrator. A one-time extension will be considered on a case-by-case basis.

  2. Caregivers who require ongoing counseling will be referred as needed.

  3. A qualified professional includes a psychologist, licensed social worker, and counselors as defined by North Dakota Century Code. Counseling may include, but not be limited to the following topics:

  1. Caregiver stress and coping

  2. End of life issues/grief counseling

  3. Family relations/dynamics

  4. Substance abuse

  5. Decision making and problem-solving

2. Support Groups: Facilitate development/maintenance of caregiver support groups.

a. Reimbursement may be provided for start-up costs for support groups that have a caregiver component on a case-by-case basis with prior approval from the NDFCSP Program Administrator. The goal is to encourage each group to become self-sustaining. Educational materials may be provided as needed.

3. Caregiver Training: Identify and arrange payment for qualified professionals to complete individualized caregiver training that meets the needs of the eligible caregiver. If the caregiver has insurance that covers the training it should be the primary payor for the training to avoid duplication of service.

a. Qualified professionals include, but are not limited to:

  1. Nurses

  2. Occupational Therapists

  3. Physical Therapists

  4. Dieticians

b. Whenever possible the training should be held in the home where care is being provided.

c. Training may include but not be limited to the following areas:

  1. Generally accepted practices of personal care tasks and personal care endorsements

  2. Assistive technology, including an assessment to address technology needs and training to use devices to participate in telemedicine visits, caregiver/care recipient education, support groups, socialization, etc.

  3. Planning for long term care needs

  4. Health and nutrition counseling

  5. Behavior management

  6. Financial literacy

d. Promote the department-approved Powerful Tools for Caregivers training.

e. For caregivers caring for a care recipient with a diagnosis of Alzheimer’s Disease or a related disorder, promote the department-approved caregiver dementia care services trainings scheduled with the department-approved provider.

4. Information Services – Public education, information, and training activities directed to large audiences including but not limited to the following:

a. Booths at health fairs.

b. Distribute FCSP brochures.

c. Posting FCSP flyers.

d. Public service announcements advertising the FCSP and services.

e. Church bulletin inserts.

f. Media events that advertise the FCSP and services.

g. Public newsletters promoting the FCSP and services.

h. Participate in coalitions and/or planning committees that focus on aging/caregiving service needs, issues, and events.

i. Public presentations regarding caregiving and grandparent older relative caregiver issues.

j. Newsletters/newspaper articles that provide information on caregiving or grandparent older relative caregiver issues.

k. Public caregiver trainings that focus on caregiving or grandparent older relative caregiver issues, i.e. dementia training.

Respite Care

1. If the physical, mental, and social well-being and safety of the care recipient can be assured, approved activities while providing respite care are those indicated in the Qualified Service Provider standards as set forth by the Department and may include:

  1. Bathing,

  2. Dressing/undressing,

  3. Feeding/eating,

  4. Toileting and/or incontinence cares,

  5. Assisting with mobility,

  6. Transferring/turning/ positioning.

  7. Light housework,

  8. Laundry,

  9. Meal preparation,

  10. Medication assistance,

  11. Providing supervision and companionship

  12. If the care recipient is physically able, accompany the care recipient to engage in activities within the local community or trade area.

  13. Assist caregiver/care recipient in using technology to stay socially connected, telemedicine, education, socialization, support groups, etc.

  14. Virtual respite may be used by using platforms such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, WhatsApp video chat, Zoom, or Skype

  15. Respite care shall be allocated on a quarterly basis and may not exceed the amount authorized on the Caregiver Option Plan (SFN 165). If services begin within the quarter, the allocation must be prorated based on the number of months remaining in the quarter.

  16. Service dollars not used within the quarter will not carry forward to the next quarter; a new allocation will be established based on usage.

  17. Individual (i.e., qualified service provider (QSP) and qualified family members) rates for respite care services shall not exceed the current maximum Medicaid QSP rate.

  18. Providers, individuals, or agencies, who have a private pay QSP rate lower than the maximum Medicaid QSP rate for respite shall be paid at their established private pay rate, not the maximum Medicaid QSP rate.

  19. For reimbursement purposes, overnight/24-hour respite care is based on the hours of 12 am (midnight) to 11:59 pm.

  20. Payment for overnight/24-hour, in-home respite provided by an enrolled QSP, qualified family member, or agency shall not exceed the current Medicaid hospital swing bed rate. Payment for one day of respite care cannot exceed the current Medicaid hospital swing bed rate whether or not the person received overnight care.

  21. Overnight/24-hour respite care provided in a hospital swing bed or long-term care facility shall not exceed the current Medicaid swing bed rate.

  22. Respite care provided in the home of a qualified service provider (QSP) cannot be authorized until a home visit and Respite Home Evaluation (SFN 549) has been completed with the QSP. The Respite Home Evaluation is not required when respite services are being provided in the home of a qualified family member or a licensed adult or child foster care home.

  23. Respite Home Evaluation (SFN 549) is valid for no longer than 24 months from the date of issuance or the date of expiration of the provider’s status as a qualified service provider (QSP), whichever comes first. The QSP expiration date can be obtained from Aging Services Division. A copy of the evaluation form must be provided to the QSP, and the original should be maintained in the provider’s file.

  24. If respite services are being provided in the community and the provider is providing transportation, the provider must sign the Non-Medical Transportation-Driver with Vehicle Services portion of the North Dakota Family Caregiver Support Program Provider Agreement (SFN 128).

  25. Caregivers and their providers who meet the eligibility for the NDFCSP Rural Differential QSP unit rate may receive a service cap adjustment over the established service cap for the enrollment period. Rural differential service cap information will be issued as changes occur. The NDFCSP Program Administrator must be notified via email every time a caregiver has been authorized to receive the rural differential unit rate and again when their enrollment has been terminated.

  26. Caregivers eligible for the FCSP rural differential respite care services unit rate may receive an overnight/24-hour care rate that exceeds the current Medicaid hospital swing bed rate. The Aging Services Division shall establish the maximum daily rate based on the rural differential care services unit rate for the current enrollment period. Overnight/24-hour care rates will be issued as changes occur.

  27. Caregivers providing care for a person with Alzheimer's disease or related dementia may be eligible to receive an enhancement of $600 over the established service cap for the enrollment period if they and at least one of their respite providers have successfully completed the FCSP approved caregiver dementia training; the allocation must be pro-rated based on the number of quarters remaining in the twelve-month enrollment period. If services begin within the quarter, the allocation must be prorated based on the number of months remaining in the quarter.

  28. Caregivers who successfully complete the FCSP-approved Powerful Tools for Caregivers training may be eligible to receive an enhancement of $600 over the established service cap for the enrollment period; the allocation must be pro-rated based on the number of quarters remaining in the twelve-month enrollment period. If services begin within the quarter, the allocation must be prorated based on the number of months remaining in the quarter.

Supplemental Services – Identify and arrange for supplemental services based on identified needs.

1. The service dollars may be made available in any combination of the following:

  1. Purchase of incontinence supplies,

  2. Purchase of assistive safety devices,

  3. Purchase of technology devices to assist the caregiver. The service cap for technology as established by Aging Services Division cannot be exceeded.

  4. Supplemental services shall be allocated on a quarterly basis and may not exceed the amount authorized on the Caregiver Option Plan (SFN 165). If services begin within the quarter, the allocation must be prorated based on the number of months remaining in the quarter.

  5. Service dollars not used within the quarter will not carry forward to the next quarter; a new allocation will be established based on usage.

  6. Contact should be made with the Assistive Safety Devices Distribution Program Service to determine whether or not the caregiver/care recipient can obtain the device through this service.

  7. Supplemental services dollars cannot be used as partial payment for an assistive safety device.

2. Disaster/Emergency Planning

  1. At the direction of the Aging Services Division, contact the caregiver to assist in planning to assure the caregiver and care recipient’s safety in the event of a disaster/emergency.

  2. Document in the Narrative Section of the Caregiver Assessment Tool the stated purpose of the contact and a brief description of the caregiver’s plan for safety.

Additional information for older relative caregivers

 

  1. Older relative caregivers may be eligible for up to an average of 10 hours a week of respite.

  2. If the caregiver is working, service dollars cannot be used during work hours.

  3. If the child(ren) is in school or regularly scheduled daycare, the service dollars can only be used for times the child is not in school or regularly scheduled day-care.

  4. On a case-by-case basis, consideration will be given to older relative caregivers’ ability to use alternate sources for respite such as summer camps, day camps, etc.

  5. Supplemental services may be authorized to assist with the cost of diapers for children who need incontinent products beyond what is developmentally appropriate. Other supplemental service dollars may only be authorized for needs above the normal needs of raising a child.