ND Medicaid Program
The Department of Human Services is monitoring flood forecast reports from the National Weather Service, and should there be flooding in North Dakota in 2020, the ND Medicaid program may submit state plan amendments and/or 1915c waiver amendments to ensure ND Medicaid members continue to receive Medicaid covered services. These flexibilities may include extending redetermination timelines for Medicaid members, extending deadlines for requesting a fair hearing, allowing early refills on prescription drugs, waiving prior authorization or primary care provider referrals for certain services, allowing Medicaid members to self-attest certain eligibility items, temporarily waiving provider screening requirements or temporarily ceasing revalidation of provider enrollments in affected areas, and allowing facilities to provide services in an alternative setting. Other flexibilities may be necessary, depending on the specific impacts and duration of potential flooding. Should the ND Medicaid program need to invoke these or other flexibilities, state plan and/or waiver amendments will be implemented as needed to secure federal approval for the flexibilities needed.
Effective for dates of service on or after April 1, 2020, ND Medicaid will be submitting a state plan amendment to remove the ICF provider requested vacancy rate add on and replace it with a vacancy factor that will be a component to the rate, intended to cover costs when a client is no longer in the setting and has no intent to return.
Effective for dates of service on or after April 1, 2020, ND Medicaid will be submitting a state plan amendment to clarify medical nutrition therapy services. The clarification will update language used to refer to limits for medical nutrition therapy. Per Current Procedure Terminology (CPT), the codes for medical nutrition therapy are based on time rather than number of units; therefore, the amendment will clarify that Medicaid members may receive four hours of medical nutrition therapy per calendar year. Services in excess of the limit may be authorized if medically necessary. The clarifications are expected to have no impact on Medicaid expenditures for a 12-month period.
Effective for dates of service on or after April 1, 2020, ND Medicaid will cover HIV screening. Medicaid expenditures for these services are expected to increase $12,000 for a 12-month period.
ND Medicaid follows the National Correct Coding Initiative (NCCI) Edits. These edits were developed by the Centers for Medicare and Medicaid Services (CMS) based on coding conventions defined in the American Medical Association's Correct Procedure Terminology Manual, national and local polices and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. CMS annually updates the National Correct Coding Initiative Coding Policy Manual.
Comments can be sent to and viewed at: Medical Services Division Room 309, ND Department of Human Services, 600 E Boulevard Ave Dept 325, Bismarck, ND 58505-0250. Questions may be directed to the local county social service office, or individuals may contact the ND Medicaid Program at 1-800-755-2604.
(March 24, 2020)