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

(Revised 07/01/22 ML #3690)

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Purpose - The purpose of the rural differential rate is to create greater access to FCSP 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.

 

  1. QSPs willing to travel a minimum distance of 21 miles round trip to provide FCSP services to authorized FCSP caregivers in rural areas may be reimbursed at a higher rate.

  2. Rural differential unit rates vary based on the round-trip mileage.

  3. 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

  1. Only enrolled agencies or individual QSPs authorized to provide FCSP services are eligible to receive the rural differential rate.

  2. Family members are not eligible to receive a rural differential rate unless they enroll as a QSP with the NDFCSP.

  3. All individual QSPs and agency employees authorized to bill using the rural differential rate will be required to submit proof of address upon request to Aging Services Division. The only proof of address accepted for North Dakota residents will be a valid North Dakota driver’s license. Once the driver’s license is received the Department may verify the address is current with the Department of Transportation.

  4. If the QSP or agency employee resides in another State, the Department may accept another form of address verification i.e., current utility bill, etc. If out-of-state residents submit other forms of identification the decision to accept it for purposes of being eligible to receive the rural differential rate will be made on a case-by-case basis.

Service Activities

 

  1. 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).

  2. The FCSP Rural Differential Rate Authorization (SFN 225) will be completed upon enrollment for each caregiver and QSP provider who meets the eligibility criteria for the rural differential rate.

  3. The distance between the caregiver’s home and the QSPs home base must be verified by using a reputable internet-based mapping service. The most reasonable route must be used. A copy of the mapped verification of distance results must be kept in the caregiver file. A copy of the mileage verification must be sent with the SFN 225 to the NDFCSP Program Administrator.

  4. The SFN 225 will be completed upon closure to include the date of case closure.

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

  6. Copies of the FCSP Rural Differential Rate Authorization (SFN 225) 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

Service Eligibility

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

 

  1. Must be eligible for FCSP services.

  2. Reside outside the city limits of Fargo, Bismarck, Grand Forks, Minot, West Fargo, Mandan, Dickinson, Jamestown, and Williston.

  3. 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.

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

  5. An exception may be requested to allow a QSP in a rural area to receive a rural differential rate when providing services in the city limits of Minot, West Fargo, Mandan, Dickinson, Jamestown, and Williston if the following criteria are met:

  1. Aging Services Division staff has reached out to a minimum of three QSPs in the local area who are unable or unwilling to serve the individual. Efforts made must be documented in the caregiver’s record and include the name of the three providers and the date the providers were contacted. A brief description of the reason for the denial must be documented.

  2. Prior approval must be received from the NDFSCP Program Administrator.

Service Delivery

  1. 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.

  2. Home base is either the individual QSP's physical address, or the agency's home office, satellite office, or employee's physical address (if they are not required to report to the home office each day because of distance) whichever is closer.

  3. 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 the rural differential may not be used.

  4. 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 the same home.

  5. If the QSP travels to the client’s home and remains in that community overnight or for a period of days, they are not eligible to claim the rural differential rate for those dates of service. The rural differential rate may only be claimed on the day the QSP travels to and from the client’s home. The QSP must use the standard QSP rate for the days they do not travel to and from their home base.

  6. Information on the rural differential unit rate will be provided as changes occur.

Addresses

  1. 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.

  2. If the QSP’s address changes, the provider must notify Aging Services Division staff within 14 days. Once Aging Services Division staff receives a notification of address change, they must recalculate round trip mileage using a reputable internet-based mapping service.

  1. Aging Services Division staff shall submit the SFN 225 noting the change of address and an updated map with the new address to the NDFCSP Program Administrator.

  2. If the QSP’s new address changes the tier the provider is eligible to bill, Aging Services Division staff must update the tier and rate on the SFN 225 and distribute as required.

  3. If the QSP no longer qualifies for the rural differential rate, the Aging Services Division staff must complete and submit an SFN 225 to the NDFCSP Program Administrator.