Training and Supports for Unpaid Caregivers (1915(i))
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Governs Training and Supports services for unpaid caregivers of eligible 1915(i) members in North Dakota, including service components, allowable purchases, provider requirements, documentation, limits, and procurement via a third-party fiscal agent.
No material clinical or coverage changes in this revision.
Coverage criteria and service limits
Coverage and requirements for Training and Supports
Services covered for unpaid caregivers of eligible 1915(i) members include a unit component (per 15-minute rate) for direct training/support activities and a funding component (annual budget) for approved training purchases procured through a third‑party fiscal agent. A member must receive the unit component to access the funding component; the unit component may be provided without the funding component.
ALL of the following
- Rate #1 — Unit component: direct training/support delivered by an individual provider affiliated with a 1915(i) group provider; billed per 15 minutes for activities such as practical living skills, parenting skills and family reunification support, home management, household and personal care instruction, use of community resources, conflict resolution, coping skills, understanding behavioral health needs and medications, communication and crisis de‑escalation, suicide safety planning, systems mediation/advocacy, coordination/transportation assistance, and assistance completing purchases through the third‑party fiscal agent.
- Rate #2 — Funding component: an annual per‑year dollar amount to purchase training and education for the unpaid caregiver; allowable purchases include conference/training registration fees, training materials, and training supplies.
ALL of the following
- A member must receive the unit component to access the funding component; the unit component provider must collaborate with the third‑party fiscal agent to obtain the funding component.
ALL of the following
- Rate #1 daily maximum: 8 hours (32 units) per day.
- Rate #2: maximum allowable training budget per year; service authorization requests exceeding limits may be reviewed if necessary to prevent imminent institutionalization, hospitalization, or out‑of‑home placement and must be initiated by the member's care coordinator.
ALL of the following
- Services must be rendered in a Home and Community‑Based setting (not an institutional setting).
- Telehealth may be used; at least 25% of benefit planning services each calendar month must be provided in person.
ALL of the following
- Providers must retain records, receipts, and original invoices for purchases made with the funding component and provide a written monthly progress update to the member's care coordinator; progress is discussed and documented at each 1915(i) plan of care meeting.
ALL of the following
- Care coordinator sends Request for Service Provider form to the training and supports provider and the third‑party fiscal agent; both providers accept and submit service authorization to the State via MMIS; the third‑party fiscal agent submits claims to the State via MMIS.
ALL of the following
- Conference registration fees, training registration fees, training materials, and training supplies are allowable uses of the funding component.
ALL of the following
- Members must be present for the service to occur; providers delivering outside a private residence (e.g., school) should ensure compliance with Home and Community‑Based setting policy.
ALL of the following
- Primary billing unit is the 15‑minute unit (see detailed billing criteria and codes in coding section).
ALL of the following
- Providers not rendering this service in a member's private residence or community‑based non‑residential setting should refer to the Home and Community‑Based setting policy for compliance guidance.
ALL of the following
- Service requirements, limits, documentation, and procurement steps must be followed as specified to maintain eligibility for both unit and funding components.
Coverage criteria for Training and Supports for Unpaid Caregiver
Coverage requires provider enrollment, practitioner qualifications, supervisor experience, and adherence to billing unit and modifier rules.
ALL of the following
- Provider must have a North Dakota Medicaid provider agreement and attest that: individual practitioners meet required qualifications; services will be provided within their scope of practice; individual practitioners have required competencies identified in the service scope; agency conducts training in accordance with state policies and procedures; and agency adheres to all 1915(i) policies and procedures with written procedures available for NDDHHS review.
ALL of the following
- Employed by an enrolled ND Medicaid provider of this service.
- Be at least 18 years of age.
- Possess a high school diploma or equivalent.
- Be knowledgeable and competent in person‑centered plan implementation.
- Experience or certification: Must have a minimum of two years of experience working with or caring for individuals in the target population OR hold an approved certification (e.g., Parent Aide, Mental Health Technician, Behavioral Health Technician, Healthy Families Home Visitor, Parents as Teachers Home Visitor, Nurse Family Partnerships Program Visitor, or other NDDHHS approved certification).
ALL of the following
- Supervisor must meet the individual practitioner requirements and have two or more years of experience providing direct support to caregivers.
ALL of the following
- Providers may bill individual or group settings. For group settings append modifier UA and reimbursement is 25% of the allowed amount. Modifier UK is noted for documentation.
- Minimum billable time: providers can bill a single 15‑minute unit for services ≥ 8 minutes. Minutes from the same day, same Place of Service, and same member can be combined to reach the 8‑minute minimum. Services < 8 minutes should not be billed. Detailed unit thresholds: 1 unit ≥ 8–22 minutes; 2 units ≥ 23–37 minutes; 3 units ≥ 38–52 minutes; 4 units ≥ 53–67 minutes; 5 units ≥ 68–82 minutes; 6 units ≥ 83–97 minutes; 7 units ≥ 98–112 minutes; 8 units ≥ 113–127 minutes; pattern continues beyond 2 hours.
ALL of the following
ALL of the following
- Agency attestations, staff qualifications, and supervisor experience must be documented and available for review; agencies must conduct training per state policies and have written 1915(i) procedures available for NDDHHS review upon request.
Billing codes, units, and thresholds
Provider responsibilities, procurement, and authorization
Funding component procurement and authorization process
Care coordinator initiates procurement by sending a Request for Service Provider form to the training and supports provider and Veridian Fiscal Solutions. After acceptance and authorization of care coordination, the approved plan of care must be sent to both the training/support provider and Veridian; the training/support provider submits authorization for the unit component and Veridian submits authorization for the funding component to the State via MMIS, each with the plan of care attached. Once State authorization is received, the training/support provider and member identify training/materials and work directly with Veridian to complete required Veridian forms; Veridian authorizes payment, issues vendor/payment disbursements, and submits their claim to the State via MMIS. Vendors do not need to be registered with the State of ND and items cannot be purchased without Veridian's approval.
- Care coordinator sends Request for Service Provider form to training/support provider and Veridian Fiscal Solutions.
- Training/support provider and Veridian accept request; after care coordination authorization, approved plan of care sent to both providers.
- Training/support provider submits unit-component service auth and Veridian submits funding-component auth to State via MMIS; both must include plan of care.
- Training/support provider and member work with Veridian to identify items and complete Veridian forms; Veridian authorizes payment and issues vendor payments.
- Vendors need not be registered with State of ND; items without Veridian approval cannot be purchased; Veridian submits claim to State via MMIS.
Provider must enroll and attest to practitioner qualifications and 1915(i) compliance
The provider must hold a North Dakota Medicaid provider agreement and attest that individual practitioners meet required qualifications, provide services within their scope, possess required competencies, that the agency conducts training per state policies, and that the agency adheres to all 1915(i) policies and procedures with written reporting and rights procedures available for NDDHHS review.
- Provider must have a North Dakota Medicaid provider agreement.
- Attest that individual practitioners meet required qualifications and competencies and deliver services within scope of practice.
- Agency conducts training in accordance with state policies and adheres to all 1915(i) policies and procedures (including individual rights, abuse/neglect/exploitation, restraints, and reporting procedures) and makes these available for NDDHHS review upon request.
Key definitions
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