Nexus-PATH Foster Care Rates 623-05-20-35

(Revised 10/1/21 ML #3637)

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PI 21-25

PI 25-25 Attachment

 

 

Nexus-PATH provides services and supports to children and families as a licensed child placing agency. Nexus-PATH is accredited by the Council on Accreditation for Services to Children and Families (COA).

 

Billing Address:

Nexus-PATH, Inc. ND
1202 Westrac Dr S, Suite 400
Fargo, ND 58103

 

Maintenance rates effective July 1, 2021:

NEXUS-PATH RATES BY PROVIDER TYPE & LEVEL	Avg. Monthly Rate (30 day)	Daily Rate
PATH TREATMENT FOSTER CARE PROVIDERS
Intensive Treatment Foster Care (ITFC)	$6,388.11	$212.94
Treatment Foster Care (TFC)	$3,460.81	$115.36
Step Down from TFC	$2,118.71	$70.62
Regular Foster Care	$2,118.71	$70.62
Flow Through	$ VARIED $	$ State Rate $

Resources:

PATH Program Components

PATH Payment Chart

 

NOTE: The “monthly” rate is provided for reference. The child’s foster care reimbursement is paid at a daily rate, specific to the actual number of days the child is in the provider placement during the service month. Foster care reimbursement is made to a licensed child placing agency (LCPA), the rate is inclusive of the administrative, training, case management and foster child costs. Foster parents are reimbursed an established daily rate directly from the agency, which is embedded within the agency daily rate.

 

The custodian, Nexus-PATH and child and family team participants will evaluate the child’s level of care quarterly. If a child begins as a treatment foster care (TFC) placement, it may be determined that a lower level of care is necessary and appropriate. When the level of care changes, the custodial case manager is responsible to notify the CFS Eligibility Unit by completing a new SFN 45 immediately.

 

Nexus-PATH MONTHLY BILLING

Payments to Nexus-PATH will not be authorized until a billing statement has been received for the appropriate service month. The amount billed is based on the level of care (ITFC rate, TFC Rate, Step Down rate, Regular rate, Flow Through rate) and number of days in placement, not to exceed the number of days in the month. Reimbursement of overlapping days of placement from one Nexus-PATH provider to another is not allowed, with the exception of secondary placements identified as a "pre-placement visit".

• Example: A child changes placement from one Nexus-PATH TFC home to another on the 3rd of the month, only one Nexus-PATH provider can be reimbursed for the 3rd. The placements must be updated in the case management system with the first placement ending on the 2nd of the month, and the new TFC provider placement beginning on the 3rd.

The Nexus-PATH billing office will send a child specific separate bill to CFS Eligibility Unit monthly. Nexus-PATH payments are not automatically calculated by the payment system and require manual data entry by the assigned eligibility worker. The bill must be kept in the foster care eligibility file for auditing purposes.

 

Itemized Bill:

1. Child specific - one bill per child
   
   
2. Provider specific - for bills containing multiple providers, each provider must have an approved placement in FRAME and payment authorization must be made to each provider based on the billed dates and amount specific to that provider. The CFS Eligibility Unit will not authorize a lump sum payment to only one provider if multiple placements exist during the billing cycle, each provider will be reimbursed based on placement dates.
   
   
3. Secondary placements in a therapeutic home when a child is in a primary treatment placement are not reimbursable (TFC to TFC). However, if the child is transitioning to a Nexus-PATH home from a non-PATH provider (Zone home, residential, etc.) the “pre-placement” can be reimbursed as a secondary placement. If a Nexus-PATH pre-placement visit is occurring from a TFC provider to a Nexus-PATH Regular provider, a secondary placement is allowed for reimbursement.
   
   
4. Irregular payments must be approved by the custodial case manager.
   
   
5. The CFS Eligibility Unit will authorize reimbursement to Nexus-PATH as the designated payee on behalf of the licensed provider.
   
   
6. Nexus-PATH will directly reimburse the foster parents.
   
   

Nexus-PATH Overpayments

If there is an overpayment made to a Nexus-PATH provider, the CFS Eligibility Unit can auto-recoup the overpayment during either the supplemental or standard check write so long as the provider has a foster care placement. An SFN 839 Foster Care Overpayment Notification will be sent to the Nexus-PATH billing office to notify them of the overpayment and provide instructions for repayment.

 

Nexus-PATH Irregular Payments

Allowable irregular payment reimbursements per policy 623-05-25-05 are approved through the custodial case manager as follows:

1. All irregular payments must be eligible and approved as set forth in policy. The custodial case manager is responsible to monitor the child’s irregular payment annual maximums allowed per category to ensure adequate funds are available prior to approval.
   
   
2. Receipts must be sent to the Nexus-PATH case worker for submission to the Nexus-PATH billing office. All irregular payments require a receipt for reimbursement. Nexus-PATH will attach the receipts to the monthly invoice. Receipts received directly from a foster parent or custodial case manager at the CFS Eligibility Unit for a Nexus-PATH provider will be returned to the custodial case manager for proper routing to the Nexus-PATH case worker.
   
   
3. Nexus-PATH will create an itemized bill with the standard maintenance rate for the specific level of care placement dates and any approved irregular expenses.
   
   
4. If Nexus-PATH’s billing office has questions regarding the amount received over and above the standard foster care rate, the custodial case manager will be contacted for placement date clarification.

 

How to Authorize the Irregular Payments in the payment system:

The ND payment system allows only two irregular payment codes to be authorized to Nexus-PATH ITFC or TFC providers:

1. Code 53 - transportation to school
2. Code 71 – parent/infant care

If a TFC provider is caring for a child in step down, regular or a flow through placement, the CFS Eligibility Unit will manually combine all allowable irregular payments to the maintenance payment for the billable month.

 

Nexus-PATH Regular Foster Care: Eligibility workers must authorize irregular payments separately when a child is placed in a Nexus-PATH Regular foster home.