End: Sunday, December 31, 2023 - 11:59 pm Categories:
Public Notice
ND Medicaid Program
Effective for dates of service on or after January 1, 2023, North Dakota Medicaid will be providing a 3.75% inflationary increase for all Nursing Facility services. ND Medicaid will be submitting a State Plan amendment to update the rate methodology for nursing facility services effective January 1, 2023. Medicaid expenditures for these services are expected to increase $15 million for a 12-month period.
Effective for date of service on or after January 1, 2023, North Dakota Medicaid will be providing a one-fourth percent inflationary increase for all Psychiatric Residential Treatment Facility services. In addition to the one-fourth percent 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 $150,000 for a 12-month period.
Effective for dates of service on or after January 1, 2023, the limits for dental oral examinations will be increased to two examinations per calendar year for adults. The limits for prophylaxis, in combination with periodontal exams, will be increased to two per calendar year for adults. Medicaid expenditures for these services are expected to have a minimal fiscal impact.
Effective on or after January 1, 2023, North Dakota Medicaid is proposing to expand their current supplemental drug rebate agreements to include value-based agreements. This will allow ND Medicaid to negotiate total drug rebate payments based on the success of the drugs in treating the conditions. The goal is to not pay full price when a medication ends up not being as effective. With medications progressing to up-front costs of $3.5 million for a single individual, ND Medicaid wants to protect our risk for when those hyper-expensive medications end up failing / not curing a member. Medicaid expenditures for these services are expected to decrease $100,000 for a 12-month period.
Effective on or after January 1, 2023, North Dakota Medicaid will be submitting a State Plan Amendment to increase the maximum per diem rate for an individual or agency provider of personal care services. Medicaid expenditures for these services are expected to have a minimal fiscal impact.
Effective for dates of service on or after January 1, 2023, 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 2023 by the General Services Administration. Medicaid expenditures for these services are expected to increase $1,000 for a 12-month period.
The capitated monthly rate for Medicaid Expansion, effective January 1, 2023, is estimated to decrease, based on actuarial certification of the rates and Blue Cross Blue Shield of North Dakota acceptance of those rates, and is expected to have a minimal fiscal impact.
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: Dec. 12, 2022