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Effective for dates of service on or after January 1, 2024, North Dakota Medicaid will be providing a 3.2% inflationary increase for all Nursing Facility services. In addition to the 3.2% inflationary increase, ND Medicaid will be submitting a State Plan amendment to update the rate limits for nursing facility services effective January 1, 2024. Medicaid expenditures for these services are expected to increase $33 million for a 12-month period.
Effective for dates of service on or after January 1, 2024, North Dakota Medicaid will be submitting a State Plan amendment to update the number of therapeutic leave days for a resident in a nursing facility to thirty days. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
Effective for dates of service on or after January 1, 2024, North Dakota Medicaid will be providing a 3.0% inflationary increase for all Psychiatric Residential Treatment Facility services. In addition to the 3.0% inflationary increase and consistent with Medicaid State Plan Authority, rates for Medicaid-eligible individuals residing in instate psychiatric residential treatment facilities will be adjusted, based on cost reports submitted by the facilities within the current rate methodology. Medicaid expenditures for these services are expected to increase $3 million for a 12-month period.
Effective January 1, 2024, pursuant to 2023 House Bill 1044, North Dakota Medicaid will be ending the Primary Care Case Management (PCCM) program. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
Effective January 1, 2024, North Dakota Medicaid will implement a nursing facility incentive program for instate nursing facilities. Nursing facilities whose cumulative score based on selected quality measures will receive an additional payment annually. Medicaid expenditures for this payment are expected to increase $8 million for a 12-month period.
Effective for dates of service on or after January 1, 2024, and consistent with approved state plan language, ND Medicaid will update the payment rate for lodging to the amount established for the month of January 2024 by the General Services Administration. Medicaid expenditures for these services are expected to increase $1,000 for a 12-month period.
It is unknown whether the capitated monthly rate for Medicaid Expansion, effective January 1, 2024, is estimated to increase or decrease at this time due to the end of the public health emergency (PHE) and unwinding efforts. There will be actuarial certification of the rates and Blue Cross Blue Shield of North Dakota acceptance of those rates. Overall, there is expected to be a minimal fiscal impact.
The benefits for ND Medicaid Expansion, as required by the Affordable Care Act and section 1937 of the Social Security Act, are provided through an Alternative Benefit Plan (ABP). Effective for dates of service on or after January 1, 2024, ND Medicaid will be submitting a state plan amendment which will clarify language for existing benefits, specifically as they relate to those under the age of 21.
To assure compliance with 42 CFR 440.345, ND Medicaid compared the benefits available under the ABP to those available under Traditional Medicaid fee-for-service. The results of this comparison showed that the ABP benefits include Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for those enrolled with ND Medicaid Expansion who are under age 21 that are consistent with the current ND Medicaid state plan regarding the delivery of these services with minimal changes.
Specific changes in this section include:
• 1915(i) – change in the WHODAS score reference to not reference the exact score needed.
• 1915(i) – changes to the language in the Alternative Benefit Plan for 21-64 year olds to match the wording in the Alternative Benefit Plan for 19-20 year olds.
• Primary Care Case Management (PCCM) Service Delivery Model – removal of this benefit as the program is ending December 31, 2023.
Medicaid expenditures for the Medicaid Expansion population are expected to be minimal 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 Health and Human Services, 600 E Boulevard Ave Dept 325, Bismarck, ND 58505-0250. Questions may be directed to human service zone offices, or individuals may contact the ND Medicaid Program at 1-800-755-2604.
Date posted: December 29, 2023