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Effective for dates of service on or after October 1, 2025, North Dakota Medicaid will be submitting a State Plan amendment for coverage of services provided by community health workers and community paramedics. Medicaid expenditures for these services are estimated to increase approximately $20,000 for the 12-month period.
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 October 1, 2025, ND Medicaid will be submitting a state plan amendment to provide coverage for community health workers and community paramedics.
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.
Effective October 1, 2025, North Dakota Medicaid will be submitting a State Plan Amendment to remove the end date for coverage for Medication-Assisted Treatment services. The coverage of MAT services will remain the same. There is no estimated fiscal impact on Medicaid expenditures for these services for the 12-month period.
Effective for dates of service on or after December 1, 2025, North Dakota Medicaid will be submitting a State Plan Amendment to provide reimbursement for rural emergency hospitals located within North Dakota. There is no estimated fiscal impact on Medicaid expenditures for these services for the 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: Sept. 29, 2025