Rural Differential Unit Rate for Qualified Service Providers 650-25-30-10-15

(Revised 1/1/14 ML 3403)

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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 NDFCSP 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

 

Enrolled agency or individual QSPs authorized to provide Respite Care or Personal Care for NDFCSP caregivers.

 

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 NDFCSP Caregiver Coordinator will complete NDFCSP Rural Differential Rate Authorization (SFN 225) upon initial enrollment for each caregiver and QSP provider who meet the eligibility criteria for the rural differential rate. When the caregiver case closes, the Caregiver Coordinator must also complete SFN 225 to include the date of case closure.

 

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

• Original to the QSP
• Copy in the caregiver file
• Copy to the Qualified Service Provider file
• Copy to the NDFCSP Program Coordinator
• Copy to the Rural Differential Program Administrator, HCBS Medical Services, responsible for rural differential program services oversight.

 

The Caregiver Coordinator will add the rural differential rate on the NDFCSP Caregiver Option Plan as caregivers become eligible for the rate.

 

The NDFCSP Caregiver Coordinator will notify the NDFCSP Program Administrator via email of every caregiver and QSP who are eligible for the rural differential rate upon initial sign up and case closure.

 

The NDFCSP Program Administrator has the responsibility to maintain a statewide database of all NDFCSP caregivers eligible for receiving the rural differential rate.

 

Service Eligibility, Criteria for

 

The rural differential rate is caregiver specific. A NDFCSP 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.

Situations where there is a discrepancy in what is considered city limits must be prior approved by a Rural Differential Program Administrator, Medical Services Division. The NDFCSP Caregiver Coordinator must send a written request for verification to the Rural Differential Program Administrator HCBS Medical Services, responsible for rural differential program services oversight and mileage verification.

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.

 

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 NDFCSP 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 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 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 client’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

 

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

Agency employees who are not required to report to their agency each day because of distance must make their address available to the NDFCSP Program Administrator’s office for verification. If a QSP states that the physical address on the QSP list is incorrect they must contact Rural Differential Program Administrator, HCBS Medical Services, or NDFCSP Program Administrator’s office of the change in their address before an authorization can be provided that includes a rural differential rate. It is not sufficient to notify the NDFCSP Caregiver Coordinator.

 

Determining Distance

 

NDFCSP Caregiver Coordinators are required to verify distance between the caregiver’s home and the QSPs home base by using the following website- www.mapquest.com. The Caregiver Coordinator is responsible to choose the most reasonable route and print a copy of the MapQuest results that must be kept in the caregiver file. A copy of the mapquest mileage verification must be sent along with SFN 225 to the NDFCSP Program Administrator and the Rural Differential Program Administrator.

• If there is a discrepancy when calculating distance, the final decision will be made by the Rural Differential Program Administrator. The NDFCSP Caregiver Coordinator must send a written request explaining the issue to the Rural Differential Program Administer.