Service Activities 650-25-45-30

(Revised 7/1/19 ML #3552)

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1. Access Assistance – Case Management includes the following activities:

• Accept and respond to referrals to the program.
• Make home visits or arrange for visits in a location convenient for the caregiver.
• 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 or documentation must be present in the narrative section of the Caregiver Assessment Tool to indicate the reason the assessment was not updated.
• Using the Caregiver Assessment Tool, develop and implement an individualized Caregiver Option Plan (SFN 165) that addresses the needs unique to the individual providing care. 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 (July 1 to June 30).
• A follow-up telephone call to the caregiver should be conducted within 30 days of enrollment.
• The Caregiver Option Plan (SFN 165) must be reviewed every three months at a minimum to monitor service usage and assure caregiver goals and outcomes are being met.
• 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).
• 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 via the mail. A copy of the Caregiver Option Plan must be mailed to the caregiver after each review date if there were changes in services or providers.
• 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.
• Create/maintain working partnerships with other agencies and organizations that provide services to support caregivers.

2. Counseling/Support Groups/Caregiver Training – Individual and Family

• 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 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. Caregivers who require on-going counseling will be referred as needed. 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:

• Caregiver Stress and Coping
• End of Life Issues/Grief Counseling
• Family Relations/Dynamics
• Substance Abuse
• Decision Making and Problem Solving

• Support Groups: Facilitate development/maintenance of caregiver support groups. 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.
• Caregiver Training

• Identify and arrange payment for qualified professionals to complete individualized caregiver training that meets the needs of the eligible caregiver. Qualified professionals include, but are not limited to:
• Nurses
• Occupational therapists
• Physical therapists
• Dietitians
• Promote the department approved Powerful Tools for Caregivers training. A list of FCSP caregivers attending Powerful Tools for Caregivers must be sent to the NDFCSP Program Administrator.
• Whenever possible the training should be held in the home where care is being provided.
• Training may include but not be limited to the following areas:
• Generally accepted practices of personal care tasks and personal care endorsements
• Assistive technology
• Planning for long term care needs
• Health and nutrition counseling
• Behavior management
• Financial literacy
• For the provision of the department approved caregiver dementia trainings, sessions must be scheduled with the department approved provider. The trainings should be limited to caregivers enrolled in the FCSP and their providers. A copy of the list of caregivers and respite providers attending department approved caregiver dementia trainings must be sent to the NDFCSP Program Administrator.

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

• Booths at health fairs.
• Mailing out FCSP brochures.
• Posting FCSP flyers.
• Public service announcements advertising the FCSP and services.
• Church bulletin inserts.
• Media events which advertise the FCSP and services.
• Public newsletters promoting the FCSP and services.
• Participate in coalitions and/or planning committees which focus on aging/caregiving service needs, issues, events.
• Public presentations regarding caregiving and grandparent issues.
• Newsletters/newspaper articles which provide information on caregiving or grandparent issues.
• Public caregiver trainings that focus on caregiving or grandparent issues; i.e. dementia training.

4. Respite Care

• A caregiver is eligible to receive funding for respite services if they are providing 24-hour care and the care recipient has two or more activities of daily living (ADL) limitations or a cognitive impairment which makes it unsafe for them to be left alone. The ADL impairment requirement for respite services eligibility does not apply to children ages 18 and under.
• Respite care services available to a caregiver cannot exceed the service cap for respite care service in a twelve-month period (July 1 to June 30) as established by Aging Services Division. Additional funds may be made available on a case-by-case basis with prior approval from the NDFCSP Program Administrator.
• Respite care must be allocated on a quarterly basis. If services begin within the quarter, the allocation must be prorated based on the number of months remaining in the quarter.
• Service dollars not used within the quarter will not carry forward to the next quarter; a new allocation will be established based on usage.
• Individual [i.e. qualified family members and qualified service provider (QSP)] rates for respite care services shall not exceed the current maximum Medicaid QSP rate.
• Providers who have an individual QSP rate different from the state maximum Medicaid QSP rate shall be paid at their established individual rate, not the maximum Medicaid QSP rate.
• Agency unit respite rates shall not exceed the current maximum rate for the service under Medicaid. Agency providers who have an agency QSP rate different from the maximum state Medicaid QSP rate shall be paid at their established agency rate, not the maximum Medicaid QSP rate.
• For reimbursement purposes, overnight/24-hour respite care is based on the hours of 12 am (midnight) to 11:59 pm.
• 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.
• 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.
• Overnight respite care services for eligible grandchildren may be provided in a licensed child foster care home. Approval from the local county social service case manager working with the child foster care home must be obtained prior to making arrangements for respite services.
• Respite care that will be 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 in a licensed adult or child foster care home.
• Respite Home Evaluations (SFN 549) are 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.
• Caregivers and their providers who meet the eligibility for the NDFCSP Rural Differential QSP unit rate will 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.
• Caregivers eligible for the FCSP rural differential respite care services unit rate will receive an overnight/24-hour care rate that exceeds the current Medicaid hospital swing bed rate. The Aging Services Division, in conjunction with Medical Services Division, will establish the maximum daily rate based on rural differential care services unit rate for the current enrollment period. Overnight/24-hour care rates will be issued as changes occur.
• Caregivers providing care for a person with Alzheimer's disease or a 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.
• 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.

5. Supplemental Services

• Identify and arrange for up to $300 in supplemental services based on identified need. The service dollars may be made available in any combination of the following:

• Purchase of incontinence supplies, not to exceed $75 per quarter; service dollars not used within the quarter will not carry forward to the next quarter
• Purchase of assistive safety devices not to exceed $300 per enrollment period

• Additional funds for supplemental services may be made available on a case-by-case basis with prior approval from the NDFCSP Program Administrator.
• Contact should be made with the Assistive Safety Devices Distribution Program to determine whether or not the caregiver/care recipient can obtain the device through this service.
• Supplemental services dollars cannot be used as a partial payment for an assistive safety device.

6. Disaster/Emergency Planning

• 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.
• 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.