Delivery Characteristics 650-25-45-20

(Revised 3/18/20 ML #3577)

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Caregiver support services must be available statewide.

  1. All referrals must be contacted within two working days of receipt of the referral.
  2. The Caregiver Assessment Tool must be completed in the web-based data collection system.
  3. Individuals seeking services must be provided with service options. The individual has the right to make an independent choice of service providers.
  4. All contacts, including telephone calls, must be documented in the narrative section of the Caregiver Assessment Tool. The documentation shall include a brief descriptive statement of the interaction, including any service needs identified, alternatives explored, and service delivery options offered.
  5. Each client and provider case record must be maintained in an individualized file and secured in a locked file cabinet, a locked area, or a restricted computer program.
  6. Service activities must be coordinated with existing community agencies and voluntary organizations to maximize service provision and avoid duplication.
  7. All services must be promoted through a variety of networks i.e., churches, service organizations, schools, professional conferences, etc.
  8. A signed release of information document for every service provider must be on file before information can be shared or released.
  9. A signed release of information document for every emergency contact must be on file before information can be shared or released.
  10. A Notice of Privacy Practices (DN 900) will be given to every caregiver and a signed Acknowledgement of Receipt of the Notice of Privacy Practice (SFN 936) will be kept in the record.
  11. Determine eligibility for rural differential rate as per the standard NDFCSP Rural Differential Unit Rate for Qualified Service Providers and complete the Rural Differential Authorization form (SFN 225).
  12. Provide services on American Indian reservations to caregivers who are not enrolled tribal members.
  13. The NDFCSP Program Administrator may grant approval for FCSP services to address special or unique service needs for up to a six-month period. Additional approval for services beyond the six-month period may be made available on a case-by-case basis with prior approval from the NDFCSP Program Administrator. Requests must be in writing in order to be considered.

  14. In the event of a state and/or national emergency or other emergencies as determined by the department, required face-to-face visits with consumers to enroll for services or to continue services may be done by alternate methods such as phone interviews or other technology. The reason for not conducting the face-to-face visit must be documented in the consumer record. A face-to-face visit must be made within 60 days following the declaration that the emergency is over.