Welcome to the September 2023 North Dakota Medicaid provider newsletter.
As we enter the harvest season it’s nice to remember that the sowing season has not really passed. “Don’t judge each day by the harvest you reap, but by the seeds that you plant.” ~ Robert Louis Stevenson
Please send ideas for future newsletter articles to dhsmed@nd.gov. We’d love to hear from you!
Meet North Dakota’s New Medicaid Director - Sarah Aker
Dear Medicaid Providers,
Thank you for caring for our North Dakota Medicaid members. I’m excited to get to know you and grow our partnership in caring for some of North Dakota’s most vulnerable populations as North Dakota’s new Medicaid Director.
I started my career in Medicaid in the South Dakota Department of Social Services, holding various roles prior to being named deputy director. In that role, I oversaw Medicaid coverage and reimbursement policy, care management, pharmacy and dental programs, and other initiatives. While deputy director, I received the State Health Official of the Year Award from the South Dakota Association of Healthcare Organizations (SDAHO) in 2019 for my work with health systems. In 2020, I joined SDAHO as the Director of Fiscal Policy, working on reimbursement and policy advocacy for hospitals and long-term care providers. In 2021, I went back to state government as South Dakota’s Medicaid Director. In that role, I led South Dakota’s team in preparing for Medicaid Expansion and working on a new care management initiative for pregnant and postpartum women. Over the last year, I participated in the Medicaid Leadership Institute as part of the 2023 Class.
I am passionate about seeing the best care and outcomes for the people Medicaid serves. As I look to the future of North Dakota Medicaid and how we can meet the needs of North Dakotans, I know that we will need your partnership as providers to meet our goal of making North Dakota the healthiest state in the nation. I hope to have the opportunity to meet and get to know you over the coming months and learn about how you are impacting the lives of Medicaid members in your communities.
I am thankful for the work of my predecessor Caprice Knapp and the leadership of Krista Fremming during the interim and the warm welcome from the North Dakota Medicaid team and the Department of Health and Human Services. They have been a great help to me in getting to know North Dakota and identifying opportunities for us to work towards better outcomes for our Medicaid members.
Although I didn’t grow up in North Dakota, I’m looking forward to making it my home. I recently moved to Bismarck with my family.
I appreciate your partnership with North Dakota’s Medicaid program and am looking forward to working with you to improve the health of our state’s most vulnerable populations.
Sarah Aker
Did you know our Health Tracks Provider Outreach Team is partnering with clinics to ensure that every eligible North Dakota child gets the healthy start they deserve?
We want to get to know you, share resources and identify areas of need where Health Tracks can assist and answer your questions.
We recently did a webinar for clinic contacts on the Health Tracks provider website and the web-based provider outreach toolkit.
Our team looks forward to expanding our clinic partnerships and improving ND Medicaid Health Tracks/Wellness Check rates across North Dakota.
If you would like to learn more about partnering with us, e-mail your clinic’s contact information to htprovideroutreach@nd.gov.
New orthodontic referral handout for Health Tracks providers
Health Tracks Provider Outreach Team has created a handout for providers to give parents, caregivers, and members when an orthodontic screening results in a referral.
Carla Kelly from Southwest District Health is your point of contact for orthodontia training and for requesting a nine-mold set. Contact Carla at 701-523-6767 to request training, which can be done in-person and online.
Medicaid Member Engagement Committee
In the coming months, ND Medicaid will be seeking applicants for a Medicaid Member Engagement Committee (MMEC). The MMEC will engage a diverse group of current and former Medicaid members to learn about their experiences and hear what they have to say about ND Medicaid. If you know a member who might be interested in applying for the MMEC, email Jen at Medicaidmembers@nd.gov or visit the committee’s webpage.
Hepatitis C criteria update effective July 1, 2023
Members who inject illicit drugs or have an alcohol use disorder and participate in a Syringe Service Program or Harm Reduction Medication Therapy Management appointments, may now meet criteria for hepatitis C treatment.
Recent changes:
- Criteria regarding use of “Holy Trinity” drug regimen has been removed.
- Prescriber requirements for initial hepatitis C treatment have also been removed.
Reminders:
- A fibrosis score is not required for prior authorization requests for treatment. Some criteria are not applicable for members known to have a fibrosis score of F2 or above.
- Hepatitis B labs are not required with prior authorization requests for treatment.
- Positive marijuana screens are not considered on drug screens. Only positive results for drugs able to be used illicitly by injection are considered on the drug screens.
- Chart notes are only required if the member does not have drug or alcohol screens, but has maintained sobriety for the past year or since their last substance use treatment program completion.
Buprenorphine coverage update effective Aug. 1, 2023
ND Medicaid is removing pregnancy and breastfeeding as criteria for prior authorization approval of transmucosal buprenorphine mono-product to align with guidance from the Substance Abuse and Mental Health Services. The guidance states that pregnancy alone is not an indication to change a member who is stable on an opioid agonist to another opioid agonist. The guidance further states that any change in medication represents a period of vulnerability to return to substance use and the added risk of returning to substance use during pregnancy cannot be overstated.
Reminder: Call provider relations at 1-800-755-2604 to request a two-month overlap period with oral buprenorphine/naloxone to reduce cravings during initiation of a long-acting injectable buprenorphine product.
ND Medicaid’s Primary Care Case Management (PCCM) Program is coming to an end. What providers need to know
The Primary Care Case Management (PCCM) Program ends on Dec. 31, 2023.
What does this mean for providers?
Providers will no longer be chosen as a primary care provider or need to write referrals for Medicaid members who need to see a specialist or have diagnostic testing.
The $2 capitation payment will end on Dec. 31, 2023.
What does this mean for members?
Medicaid members who are in the PCCM Program will be enrolled into Medicaid’s benefit plan called Fee for Service (FFS). The member does not need to do anything. This change starts Jan. 1, 2024. Medicaid coverage will not stop for any member.
ND Medicaid will send more information to all providers, their affiliations and members later this year.
New Dental Services
ND Medicaid covers screenings and assessments as well as case management services effective July 1, 2023.
D0190 – screening of a patient
D0191 – assessment of a patient
These services may be done at the time of a ND Medicaid Health Tracks/Wellness Check in a school setting, via teledentistry, or in addition to other dental services (i.e., fluoride varnish or prophylaxis). Each service is limited to one per calendar year.
ND Medicaid is also covering dental case management services - codes D9991-D9994 and D9997. Dental case management is a program that is designed for members with mental, physical and/or behavioral health care needs who are unable to schedule and/or coordinate complex treatment plans involving one or more medical or dental providers. Limit: two per calendar year.
Dental case management may involve addressing appointment compliance barriers, care coordination, motivational interviewing, patient education and special health care needs.
Read the full policies
Dental Screening and Assessment policy
Dental Case Management Policy
Did you know?
Medicaid data dashboards
You can find information on Medicaid renewals, eligibility, health care quality measures and more on the data dashboards webpage.
Recommending Additional Medicaid-Covered Services
Providers can fill out the SFN 905 form to request that ND Medicaid add coverage options for noncovered services and/or providers.
Stay in the know! Medicaid provider newsletter subscription
Signing up to receive ND Medicaid’s quarterly provider newsletters is easy.
Step 1: Go to the Provider webpage.
Step 2: Enter your email address and click submit.
Step 3: Follow directions to set up and choose your subscription options. Select Medicaid Provider Newsletter.