Medicaid Member Engagement Committee (MMEC)

Agenda

Welcome & Ice Breaker

• Roll Call
• Meet & Greet
• Ice Breaker

Discussion

• Past topic follow-ups
• Member handbook review
• Community-based organization outreach work
• Q&A
• Sharing
• Feedback update

Next Steps

• Reminder for Next Meeting
• Upcoming Meetings

Minutes

Welcome & Ice Breaker

• Meeting called to order: 11:00 a.m.
• Meeting adjourned: 12:43 p.m.
• Welcome
• Roll Call
  • Members present:
    • Kara Handson
    • Ashley Roulette
    • Eldor Scheid
    • Allison Wanner
    • Jackie Frost-Hodney
  • Members absent:
    • Victoria Alexander
    • Heather Skadsem
  • Also in attendance:
    • Jen Sheppard, Member Liaison
• Icebreaker

Discussion

• Past topic follow-ups
  • Out-of-state services advocates
    • Two employees assist members to navigate these services.
    • We have identified that we are needing to better promote this resource.
    • We plan to add this information periodically to E-News.
    • This information has been added to the Medicaid Member Handbook.
  • Website eligibility calculator
    • Other states suggest that most feel this could confuse/mislead applicants.
    • We have a similar eligibility tool on our Apply for Help webpage.
    • Recommended to place this tool on the Medicaid Eligibility webpage with explanation of which assistance programs are included.
    • Include disclaimer that this tool only tests and does not guarantee eligibility.
  • Member Engagement webpage review
    • Use the Customer Support Center name in the feature area.
    • The Self-Service Portal (SSP) should clarify whether to use the member’s or the guardian’s information when creating an account.
    • The MMEC requests explanation for use of client ID numbers instead of ND Medicaid numbers.
  • Member Handbook search bar
    • This work has been approved and is in progress.
  • Simplify the client share billing process
    • Steps have been taken including updating provider forms, adjusted Therap processes, created a Provider Education team, gathering dental billing feedback, and implemented a policy feedback process.
  • Add ND Navigator information to member notices
    • Approval was given to add ND Navigator purpose and contact information.
    • Reflection on the MMEC’s place in the change management process
    • Centers for Health Care Strategies (CHCS) training and recent experiences show that the MMEC recommends change but may not be able to implement change.
    • We should identify which actions this committee can take, and which are best taken by other ND Medicaid stakeholder groups, committees, or units within Medical Services.
  • Medicaid Member Handbook review
    • Family Planning Services chapter
    • Recommendations/edits were made for what this chapter should contain.Laboratory, Radiology, and Diagnostics chapter
    • Recommendations/edits were made for what this chapter should contain.
  • Community-based organization outreach work
    • We have partnered with the Justice Well program to host a listening session and survey in May.
    • We will advertise these opportunities in the March and May issues of E-News, social media posts, and on our website.
  • Listening session invite
    • May 6, 2025 @ 3:00 p.m. – 4:30 p.m.
    • Our first listening session will be held virtually on May 6, 2025.
    • Reimbursing MMEC members for travel will not be possible until after May.
  • Medicaid Medical Advisory Committee
    • Five seats are held for MMEC members
    • Please submit applications to saker@nd.gov
    • One member expressed interest in applying to the MMAC.
  • Results from the 2023 Consumer Assessment of Healthcare Provider and Systems (CAHPS) survey
    • This survey captured an 8.1% response rate.
    • This survey reflects: access to health care services, customer service, and experience with applications and coverage ratings.
• Q&A
  • Does our website have a feature where we can hover to get more information without seeing so much information right away?
    • This will be explored.
• Sharing
  • Reduce the amount of content on the main Medicaid webpage and find places for added information. Let this page only offer pages to visit for applicants, members, and providers.
  • Correspondence times are lengthy for denials.
  • The billing process is too complicated for providers.
  • Reimbursement rates are too low for providers.
  • Member notices about coverage changes should be on colored paper or have a callout.
  • Medicaid premium payments are being processed inaccurately, and members are getting conflicting guidance.
  • Calling into the Customer Support Center resulted in immediate disconnection. Have a message that explains call wait times are high and to call back later.
  • Recent out-of-state referral experience was pleasant and helpful.

Next Steps

• Reminder for next meeting
  • May 6, 2025 @ 9:30-11:30 a.m.
• Upcoming meetings
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

MMEC Meeting Minutes 3/4/25

Agenda

Welcome & Ice Breaker

• Roll Call
• Meet & Greet
• Ice Breaker

Guest Speakers

• Client share/Recipient liability: Laura Holzworth

Discussion

• Past Topic Follow-Ups
• Member handbook review
• E-News review
• Suggestions for Appeals Member Handbook
• Member resignation
• MMEC meeting facilitation discussion
• Applying for the MMAC
• Partnership with Justice Well Program
• Q&A
• Open Discussion
• Reflection on Medicaid enrollment and billing statistics

Next Steps

• Reminder for Next Meeting
  • March 4, 2025 @ 10:30-12:30 p.m.
• Upcoming Meetings
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

Minutes

Welcome & Ice Breaker

• Meeting called to order: 9:30 a.m.
• Meeting adjourned: 11:00 a.m.
• Welcome
• Roll Call
  • Members present:
    • Victoria Alexander
    • Heather Skadsem
    • Kara Handson
    • Ashley Roulette
    • Eldor Scheid
    • Allison Wanner
    • Jackie Frost-Hodney
  • Members absent:
    • N/A
  • Also in attendance:
    • Krista Fremming, Assistant Director
    • Monique Runnels, Tribal Liaison
    • Jen Sheppard, Member Liaison
    • Laura Holzworth, Provider Relations Supervisor
• Meet & Greet
  • New member: Ashley Roulette
• Icebreaker

Guest Speaker

• Client share/Recipient liability: Laura Holzworth
  • High level overview of client share, how it is calculated, member responsibilities, how it is applied to medical bills, and who to contact for help or questions.

Discussion

• Past topic follow-ups
  • Search bar for member handbook:
    • We can create a search bar for just the handbook. There is cost for this work. We will publish all chapters, work toward ADA compliance, then re-visit this topic.
  • Chat Bot:
    • The state website is trialing a chat bot. This could help us understand the benefits and challenges if we get a chat bot on the hhs.nd.gov website.
• Review Member Handbook
  • Chapter review: Where to Find Health Care. The MMEC felt:
    • This chapter is useful and necessary.
    • We should explain that the facilities listed are not the only ones available in ND.
    • We should define the term ‘facilities’, define acronyms more frequently, and links to find facilities should go to directories rather than the webpage with links.  
• Develop March E-News
  • The MMEC reviewed the theme and topics for the March issue.
  • They suggested acknowledging March as colorectal health month.
• The MMEC was asked for topics for a future appeals member handbook. The MMEC suggested:
  • How to find help navigating the appeals process.
  • Offer materials or staff that can prepare members for what to expect.
    • Use storytelling to share what to expect during the appeal process.
    • Refer to ed.gov and the office of Civil Rights website for examples.
  • Members can ask providers for a letter of support for their appeal.
  • Include a link for the SFN-905 form to request coverage for a service that was denied.
  • Guide members in understanding which law/policy is impacting the decision.
  • Include a member advice section where member share their advice:
    • You can get an attorney, but it will be at your own cost.
    • Some members feel that you have more voice with self-representation.
• Member resignation
  • Jon Fettig will be stepping down from his seat on the MMEC.
• Reflection on MMEC facilitation practices:
  • How can we foster interest, attendance, and engagement?
    • Offer agenda and materials in advance.
    • Respect the designated time frame for meetings.
• Five members are encouraged to apply for the Medicaid Medical Advisory Committee (MMAC) starting February 2025.
  • Send applications to saker@nd.gov.
• ND Medicaid has partnered with the Justice Well Foundation to gather member feedback and identify potential applicants for the MMEC.
• Q&A
  • Can client share billing process be simplified to ease the pressure on providers and members?
    • This information will be brought back to the correct unit.
  • Can our website offer a calculator tool that figures client share amounts?
    • This question will be brought back to the Communications and Eligibility unit.
• Open Discussion
  • Requested information on legislative activity that pertains to ND Medicaid.
    • North Dakota Legislative Branch webpage was shared.
  • Suggestion made to connect with legislators to find MMEC applicants.
    • This will be considered throughout our partnership with Justice Wells.
  • Request for more information on the MMAC.
    • MMEC was invited to the next MMAC meeting on Tuesday, February 20, 2025.
  • Recipient liability is a confusing term.
    • We are shifting to the term ‘client share’.
  • Monthly client share reviews are too frequent and suggested reviewing quarterly.
    • This information will be brought back to the correct unit.
• So you know:
  • Updates on statistics or data from October and November 2024.

Next Steps

• Reminder for next meeting
  • March 4, 2025 @ 10:30-12:30 p.m.
• Upcoming meetings
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

MMEC Meeting Minutes 1/7/25

Agenda

Welcome & Ice Breaker

• Roll Call
• Meet & Greet
• Ice Breaker

Guest Speakers

• Appeals: Storm Olson, Attorney

Discussion

• Last Meeting’s Follow-Ups
  • Requesting advocates for out-of-state services coordination
• Member handbook review
• E-News review
• Review of this year's MMEC concerns and progress

Q&A

Open Discussion

Decisions

• Vote for 2-year term lengths for MMEC seats

Next Steps

• Reminder for Next Meeting
  • January 7, 2025 @ 9:30-11:30am
• Upcoming Meetings
  • March 4, 2025
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

Minutes

Welcome & Ice Breaker

• Meeting called to order: 9:30 a.m.
• Meeting adjourned: 11:00 a.m.
• Welcome
• Roll Call
  • Members present:
    • Allison Wanner
    • Kara Hanson
    • Victoria Alexander
    • Eldor Scheid
    • Jacqueline Frost-Hodney
  • Members absent: 
    • Jon Fettig
    • Heather Skadsem
  • Also in attendance:
    • Krista Fremming, Assistant Director
    • Monique Runnels, Tribal Liaison
    • Jen Sheppard, Member Liaison
    • Storm Olson, Attorney
    • Aaron Webb, Attorney
• Meet & Greet
• Icebreaker

Guest Speaker

• Appeals: Storm Olson, Aaron Webb
  • The MMEC was informed on appeals, denials, and reduction or termination of coverage. They were told how, where, and who can file appeals. We discussed the significance of the 30 days from the mailing date on notices, filling out State Form Number-162 notice for hearing, release of information, authorized representatives, and legal counsel. The review process and next steps were explained. Resources for information on appeals was shared. The MMEC was told that the Legal division is reviewing how appeal information is provided. The Document Number-263 that is sent with notices may be revised. 
  • The MMEC learned that an appeal can be filed to District Court. If members disagree with the court’s decision on an appeal, they can request a rehearing or reconsideration hearing. They must provide information as to the reason. There must be new evidence that the law was applied incorrectly. It was recommended to have an attorney represent the member; however, the system is designed for those who appear without an attorney and judges often provide some grace for those who don’t have an attorney.
  • The MMEC asked for a list of non-appealable denials and found that there is not a full list published. There are too many examples to list, and some are only appealable by a provider while others are only appealable by the recipient.
    • The MMEC recommended publishing a list of non-appealable denials.
      • A description of denial differences and examples will be added to the member handbook.  
  • The MMEC was invited to create a list of information or topics they recommend be included in public-facing appeals information.

Discussion

• Last meeting’s follow-ups
  • The MMEC requested advocates for members needing out-of-state services. 
    • Two employees are in-place to assist members with questions and directives as needed.
    • Members requested contact information for the Out-of-State Services unit to members.
      • This information will be added to the member handbook and considered for a future E-news article. 
• Member handbook, Emergency Health Care chapter review
  • The MMEC reviewed the full chapter and recommended adding how to address medication management concerns outside of an emergency room. The MMEC also requested adding information on necessary ambulance use for non-emergency, in-state transportation, and the option to use an ambulette. 
    • This information will be added to the member handbook.
  • The MMEC had suggested prominently displaying information on translation ability for the online member handbook. They reviewed a proposed approach to added verbiage at the top of the handbook webpage. One suggestion was to not include a screenshot image of the translation tool to reduce confusion. 
• E-News Review
  • The MMEC reviewed articles for the January issue and suggest adding a reminder for renewals. The committee was asked to submit suggestions for future articles. One suggestion was to cover dual special needs plans information. 
• Review this year’s MMEC concerns and progress.
  • The MMEC reflected on this year’s work and recognized our progress in applying best practices for plain language in member-facing materials, website navigation, and increasing access to information through member E-News and the member handbook. We reviewed ongoing work in efficiency, member clarity for processes, member handbook development, website work, increasing coverage, and Self-Service Portal improvements. 
• Q&A
  • One member asked if we have information in the member handbook about Medicaid coverage being secondary to other health insurance coverage.
    • The member handbook will have this information in a future chapter. 
• Open Discussion
  • The MMEC suggested adding information into the member handbook for primary vs. secondary coverage for out-of-state services.
    • This will be considered for a future handbook chapter.
• Decision: Vote for term length of MMEC members: 
  • Two-year term:
    • Four members voted for a two-year term.
  • Three-year term:
    • One member voted for a three-year term. 
  • The MMEC will have seats with two-year terms. These terms will be non-consecutive to comply with Centers for Medicare and Medicaid Services (CMS) Ensuring Access to Medicaid Services final rule. This information will be updated in the MMEC Guidelines and published.

Next Steps

• Reminder for next meeting
  • January 7, 2025 @ 9:30-11:30am
• Upcoming meetings
  • March 4, 2025
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

MMEC Meeting Minutes 11/5/24

Agenda

Welcome & Ice Breaker

• Roll Call
• Meet & Greet
• Ice Breaker

Guest Speakers

• Out-of-State Services: Susan Burns and Rachael Buckwitz
• MMAC: What is the MMAC, the Access Rule, and how to apply: Mandy Dendy

Last Meeting’s Follow-Ups

• Other states term lengths for member engagement committees

Discussion

• Learning and Action Series Training 
• Member Notices best practices
• Member News best practices and topics
• Q&A
• Sharing

Next Steps

• Reminder for Next Meeting
  • November 5, 2024 @ 9:30-11:30am
• Upcoming Meetings
  • January 7, 2025
  • March 4, 2025
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

Minutes

Welcome and Icebreaker

• Meeting called to order: 9:30am
• Meeting adjourned: 11:30am
• Welcome
• Roll call of committee members present:
  • Jon Fettig
  • Jacqueline Frost-Hodney
  • Heather Skadsem
  • Eldor Scheid
• Members absent: 
  • Victoria Alexander
  • Kara Hanson
  • Allison Wanner
• Also in attendance: 
  • Jen Sheppard (Member Liaison)
  • Mandy Dendy (Policy Director)
  • Monique Runnels (Tribal Liaison)
  • Susan Burns, Utilization Review Administrator
  • Rachael Buchwitz, Utilization Review Administrator
• Meet & Greet
• Icebreaker

Guest Speaker

• Out-of-State Services: Susan Burns
  • Brief overview of how out-of-state services and travel assistance that is offered and approved.  
  • MMEC member suggestions:
    • One MMEC member shares they had out-of-state services not approved for the Medicaid member. The time allotted to appeal the Medicaid decision was 30 days. This did not leave enough time to communicate back-and-forth with Medicaid on the appeal decision.
      • The 30 days starts over with each determination. 
      • Some providers may offer a referral even if the service can be offered in ND. This can create confusion for the member. Providers need to share a reason why an out-of-state service is necessary with Medicaid when seeking authorization for these services. 
  • MMEC member questions:
    • Can family/caregivers of Medicaid members get travel assistance?
      • Yes. ND Medicaid is enrolling family members as Non-Emergency Medical Transportation (NEMT) providers. Family members must enroll as an NEMT provider and can find out more by connecting to our Customer Support Center or the out-of-state travel specialist at 701-328-2159.
      • NEMT travel assistance may apply to out-of-state travel also.
    • Why do out-of-state services require a prior authorization?
      • This process comes from federal and state guidance. It is most cost-effective to have services offered in ND rather than outside of the boundaries. 
      • Having a provider closer to home who knows the member and their health history can improve the level of care. 
    • Why would members request out-of-state services?
      • Some members keep their ND Medicaid coverage as they relocate to college or a new foster care location near or outside of ND borders. 
      • Members may want to keep the same provider for continuation of care or remain in the same coverage network. Members can see providers up to 50 miles outside of the ND border. 
      • Depending on location, some members may need to visit an out-of-state hospital when that is the closest facility in times of urgent need.
• Medicaid Medical Advisory Council (MMAC): Mandy Dendy
  • Updates on MMAC term lengths for MMEC members, final rule requirements, open seats available to
    • MMEC members, and how the MMEC and MMAC work together were shared. 
      MMAC is made of 25 seats. Members must apply for a seat. Members outside of MMEC members serve three-year terms. Terms cannot be consecutive. This council is made of ND Medicaid members, medical professionals, legislators, and others connected to Medicaid create a well-rounded perspective. 
    • This council is notified of changes within Medicaid such as state plan amendments or waiver changes and are offered educational updates. The MMAC makes suggestions, shares ideas, and gives feedback. 
    • Five MMEC members will need to join the MMAC. Seven seats will open in February of 2025. MMEC members can apply to the MMAC by sending an email to the Medical Services Director with their reason for serving and information about themselves, their health care experiences, and their Medicaid connection.
      MMAC meetings are a combination of virtual, hybrid, and in-person. 
  • MMEC members were asked what MMAC term length would be best for MMEC members? 
    • Members feel that three years is a long commitment.
    • Members agree that two years may be best.
    • Offer a potential three-year term with an option to step down at two years. Some MMEC members may feel over-burdened with a three-year commitment while others may feel strengthened by the experience gained with a longer term limit. 
      • Mandy Dendy will take this information back to the November MMAC meeting.

Last Meeting's Follow-ups

• What term lengths have other states established for their member-based committees?
  • Nevada: 2 years
  • California: 2 years
  • Arkansas: 2 years
  • Indiana: 2 years 

Discussion

• Learning and Action Series Training:
  • Center for Health Care Strategies accepted North Dakota’s Medicaid member engagement team to a 14-month-long, nation-wide training series.
  • This training will offer peer-to-peer discussion, individual training, action plan development for member-based committees, and assistance in forming partnerships with community-based organizations to better connect with Medicaid members. 
  • This training started this July and will continue through the fall of 2025.
• Member Notice Review:
  • MMEC reviewed a recent notice to all Medicaid home oxygen therapy use members.
  • MMEC members were asked for input in the following areas:
    • Is there a clear call to action?
      • Yes, but could bold text to identify important information more easily.
      • Consider making a header with a strong statement that catches the reader’s attention.
    • Do we have information that isn’t needed?
      • No.
    • Did we miss information that should have been included?
      • Clarify that the device being offered is paid for by Medicaid.
      • Rely less on the term “covered” or “will cover” as some readers may not understand that this is related to cost. 
      • Clarify if installation of this product can be done by the member or should be done by a professional.
    • Will readers stay engaged based on length and content of the letter?
      • Length of letter is good at one page.
      • Break up sentences that introduce two main points so one point is not overlooked.
  • MMEC member suggestions:
    • Bold any links. 
    • QR codes are good and necessary.
    • Consider an even lower reading level for writing style. Aim for a fifth-grade level. 
  • MMEC member questions:
    • Do we have a way to send these letters to specific members?
      • Yes. We can identify members that have a specific diagnosis or order for oxygen/oxygen therapy supplies.
• Member News Review:
  • E-News
    • How do you feel about the current frequency of every other month?
      • This is good. More frequent delivery would reduce the likelihood that recipients will read due to an overwhelmed in-box.
  • What topics should we cover?
    • New changes.
    • Contact information.
    • Having a theme for each issue is helpful.
    • Appeal process information.
  • Printed Annual Newsletter
    • How do you feel about the current frequency of once per year in November?
      • Timing is good.
      • Avoid major holiday seasons, aim for beginning of November.
    • What topics should we cover?
      • Commonly needed contact information.
      • How to access more information. Make sure website and phone numbers are offered.
    • Other feedback:
      • QR codes are good and necessary.
      • Give members the option to receive the annual newsletter electronically to save on cost. 
• Q&A 
  • How does the MMEC feel about guest speakers attending meetings?
    • Guests may hinder members’ willingness to share their thoughts and opinions openly.
    • Guests should present their reasons for wanting to attend.
    • There should be a small, set number of guests.
    • MMEC members should be notified in advance.
    • MMEC members should be well-established on the committee (after one year of attendance for the majority).
    • The MMEC meetings should not have visitors directly after a new member has joined.
• Open Discussion
  • MMEC members request a quest speaker on the ND Medicaid appeals process.
    • Member liaison will organize requested guest speaker.
  • One MMEC member shares that out-of-state services can be confusing and complicated processes may lead to poorer health outcomes. 
  • One MMEC member suggests considering the member and/or caregivers experiencing out-of-state services. These times can be overwhelming or stressful for those involved. Explore ways to build in ways to help relieve members and/or their caregivers having to get out-of-state services. Having an assigned advocate to assist with arrangements, appeals, etc. could help relieve added pressure for this process. 
  • One member shares their experience with out-of-state services being needed and then approved and now being denied. This member expressed the frustration of this situation. 

Next Steps

• Reminder for next meeting
  • November 5, 2024 @ 9:30-11:30am
• Upcoming meetings
  • January 7, 2025
  • March 4, 2025
  • May 6, 2025
  • July 8, 2025
  • September 9, 2025
  • November 4, 2025

MMEC Meeting Minutes 9/10/24

Agenda

Welcome and Icebreaker

• Roll call
• Meet & Greet
• Icebreaker

Guest Speaker

• Blue Cross Blue Shield Medicaid Expansion: Jared Ferguson

• Behavioral Health: Monica Haugen

Discussion

• Last meeting's follow-ups
• CMS Final Rule Review
• Medicaid Renewal Information Placement on Website
• Q&A
• Open Discussion

Next Steps

• Reminder for Next Meeting
  • September 10, 2024 @ 9:30-11:30am
• Upcoming Meetings
  • November 5, 2024

Minutes

Welcome and Icebreaker

• Meeting called to order: 9:30am
• Meeting adjourned: 11:30am
• Welcome
• Roll call of committee members present:
  • Allison Wanner
  • Kara Hanson
  • Heather Skadsem
  • Eldor Scheid
  • Jacqueline Frost-Hodney
  • Jon Fettig
• Also in attendance: 
  • Jen Sheppard (Member Liaison)
  • Mandy Dendy (Policy Director)
  • Monique Runnels (Tribal Liaison)
  • Jared Ferguson (Medicaid Expansion Administrator)
  • Monica Haugen (Behavioral Health 1915(i) Administrator)
  • Bobbi Holzworth (Medicaid Data Administrator)
• Members absent: 
  • Victoria Alexander
• Meet & Greet
• Icebreaker

Guest Speaker

• Blue Cross Blue Shield Medicaid Expansion: Jared Ferguson
  • High-level overview of the Medicaid Expansion program
• Behavioral Health: Monica Haugen 
  • High-level overview of the 1915(i) Behavioral Health Supports and Services program

Discussion

• Last Meetings Follow-ups
  • Medicare vs. Medicaid
    • Reviewed prepared slides giving a brief overview of how Medicare and Medicaid work.
  • Self Service Portal (SSP): Tabs don’t look like they can open but can. Make this more obvious.
    • There has been a recent testing of the SSP by various users to see how we can make the SSP more user-friendly. 
    • The testing results have been received and next steps are to form a plan to address concerns. 
    • The concern for the tabs has been noted and will be considered in the plan to address SSP testing results. 
• CMS Final Rule Review
  • Membership terms: 
    • CMS final rule states MMEC members cannot serve consecutive terms.
    • How long should each MMEC term be?
      • Majority of MMEC members agreed on two-year terms.
      • MMEC requests research on other states’ practices.
        • Member Liaison will research this before next meeting.
    • How many nonconsecutive terms should MMEC members be able to serve?
      • MMEC members recommend between 2-4 terms.
  • MMEC is required to hold one in-person meeting plus one hybrid meeting option per year.
    • Where should this meeting take place?
      • Bismarck unless a more central location can be identified based on current members.
  • Medicaid Medical Advisory Council (MMAC) attendance and reporting out.
    • Seven MMAC seats will open by February of 2025 and five are required for MMEC members.
    • MMEC members will rotate to attend quarterly MMAC meetings.
    • MMAC is required to hold one in-person meeting plus one hybrid meeting option per year.
    • How long should MMEC member terms be on the MMAC?
      • MMEC recommended the term lengths should reflect MMEC term lengths.
    • Interest in serving on MMAC was shown by:
      • Jacqueline Frost-Hodney
      • Eldor Scheid
      • Allison Wanner
• Medicaid renewal information must be moved to a permanent location on our webpage 
  • What information will we display?
    • Descriptive language that tells what a renewal is and how often it happens.
    • Make information stand out on webpage using contrast, color, etc.
    • Reduce amount of information being displayed on a single page.
  • Where will this information be located?
    • Add a new card on the member webpage that leads to a page that offers information about managing your Medicaid coverage.
  • Reviewed other states’ approaches:
    • Pennsylvania’s button at top of website.
    • Virginia’s section for updating contact info.
    • Arkansas’s warnings at top of website.
• Q&A 
  • What are we doing to address the provider shortage in ND?
    • Outside of ND Medicaid, state licensing boards are looking at provider scopes of practice, licensure requirements, and reciprocity. 
    • ND Medicaid can reimburse lower-level certifications in behavioral health such as mental health technicians and peer supports, which broadens the provider pool and results in greater access to care for our members. Community health workers are also coming into Medicaid.
    • We look to partner and support efforts to increase the healthcare workforce across North Dakota.
• Open Discussion
  • Concern was shared for lower reimbursement for dentists.
  • Concern was shared for lower reimbursement and difficulty billing for speech therapists.
  • Website critique
    • There is too much content per page.
    • The main drop-down menu is overwhelming.
    • The website is challenging to navigate.
  • Concern was shared for out-of-state referrals being denied.
    • Members believe there is not a provider within ND that can offer the treatment needed and do not understand their denial.
      • MMEC members request a defined escalation process and/or specialized staff to handle these issues. 
      • MMEC members recommend assigning a staff member to avoid being assisted by a different person every time. 
  • Concern was shared for referrals for treatment being made by providers but then deemed not medically necessary by ND Medicaid
    • Members recommend having an assigned staff member who can explain the how’s and why’s of the referral and denial processes per case.

Next Steps

• Reminder for next meeting
  • September 10, 2024 @ 9:30-11:30am
• Upcoming meetings
  • September 10, 2024
  • November 5, 2024

MMEC Meeting Minutes 7/9/24

Agenda

Welcome and Icebreaker

• Roll call
• Meet & Greet
• Icebreaker

Discussion

• Last meeting's follow-ups
• New topics
• Q&A
• Open Discussion

Next Steps

• Reminder for Next Meeting
• Annual Meetings

Minutes

Meet & Greet and Icebreaker

• Meeting called to order: 9:30am
• Meeting adjourned: 11:30am
• Roll call of committee members in attendance:
  • Victoria Alexander
  • Kara Hanson
  • Eldor Scheid
  • Jacqueline Frost-Hodney
  • Heather Skadsem
  • Allison Wanner
• Members Absent: 
  • Jon Fettig
• Also in attendance:
  • Mandy Dendy, Policy Director
  • Monique Runnels, ND Medicaid Tribal Liaison
• Introduction and welcome for new members
• Icebreaker

Discussion

• Last meeting's Follow-ups
  • MMEC made suggestions for staffing and features to enhance communication between members and ND Medicaid. They asked:
    • Can we create a chat box on our website that can assist visitors with website navigation and general Medicaid questions?
      • We are looking into this.
    • Can a search bar for just the Medicaid Member Handbook be created within the handbook or its webpage?
      • We are looking into webpage-specific search bars.
    • Can specific words be typed into the main search bar to lead visitors directly to handbook?
      • We are looking into this.
  • MMEC raised concerns about coverage of specific services.
    • Can members pay for the difference between a non-transition bifocal and a transition bifocal because this lens is not covered by ND Medicaid?
      • Discussed medical necessity and Medicaid coverage of items that meet a member’s needs and currently this is not an option.
      • An SFN form to request increases to coverage for specific items was shared. 
      • We reviewed ways for members to more easily access information through the handbook.
    • MMEC recommends increasing reimbursement for transportation.
      • Provider rates will be increased effective July 2024
      • There will be an article on non-emergency transportation in a future E-Newsletter issue.
  • MMEC recommends offering a Care Specialist/Guide Position for members with complex health needs to help guide them in finding the right care.
    • MMEC was asked,” What members would need this position outside of members who are assigned a case manager?”
      • No MMEC members have had experience having a case manager with Medicaid, though several are caregivers of members with complex health needs.
    • MMEC discussed best practices by commercial insurance companies such as auto-assignment of a case manager and frequent check-in’s by case manager.
    • MMEC suggests ND Medicaid could auto-assign a case manager based on a member’s diagnoses or medical treatment frequency.
    • MMEC suggested that case managers could reduce cost to ND Medicaid by assisting members in knowing where to go for treatment vs. seeing multiple providers to find the care they are needing.
    • MMEC was asked if primary care providers could fill this care coordination role and members thought this wasn’t always an option. 
  • MMEC reviewed the ND Medicaid provider list and asked questions.
    • How often are provider lists updated?
      • These lists are updated monthly. 
    • What will be the layout of the provider lists now that the Primary Care Case Management (PCCM) program has ended?
      • We are currently working on improving the user-friendliness for these lists.
• New topics
  • We reviewed the purpose of the MMEC and how we can impact ND Medicaid members.
    • MMEC should focus on topics that affect the majority of ND Medicaid members.
    • MMEC can increase member knowledge of ND Medicaid practices.
  • MMEC members were asked to test the hhs.nd.gov website and reported:
    • Some found use and navigation easy while others were confused and unintentionally re-directed to other locations on the website.
    • Not all MMEC members were able to complete this task.
    • Members didn’t identify any shared areas of concern at this time.
  • MMEC reviewed the last issue of the E-Newsletter and recommends:
    • Short length, enticing titles, keeping imagery, and keeping links.
    • Placing a URL on the E-Newsletter flyer.
    • Social media posts of E-Newsletter articles would be beneficial.
    • MMEC was asked suggest topics for future E-News articles. 
  • MMEC reviewed the Medicaid Member Handbook (chapters 1-4) and made the following recommendations:
    • Add directions/links for members of Medicare and BCBS Expansion to find correct webpage.
    • Language translation should be more prominently displayed on the webpage or in the handbook.
    • Add a ‘close’ button under each section to avoid scrolling back up to close sections.
    • Keep less content in chapters and use links for more information when needed.
    • Add more detailed information on covered services in this document, reducing need to use the call center to find information.
      • We are exploring ways to strike a balance between too much information and not enough information.
    • Include a list of non-covered services.
    • Include a pdf version for printing capabilities.
    • Add general Non-Emergency Medical Transportation information and rates to reduce calls into call center.
    • Add instructions for viewers of the Provider Directory to call their chosen provider to see if they are taking new patients and accepting Medicaid.
      • Additions have been made to the handbook draft.
• Q&A
  • Do Medicaid and IHS work together or separate?
    • Monique Runnels briefly described how tribes bill differently, how referrals work, and tribal care coordination.
  • Is there a way to request a case manager?
    • We are looking into this.
  • What does Medicaid offer for guide/support?
    • We are looking into this.
• Open Discussion
  • MMEC shares that there needs to be more information on Medicaid and IHS for members.
    • Monique shares that we are conducting tribal consultations and care coordination agreements are in place.
    • We will work on future content within the handbook and E-Newsletter.
  • MMEC shared that members need help and guidance with appeals. They shared:
    • The process is intimidating and confusing for members.
    • Past experience showed that there was no advocate present for members during appeals.
    • Requesting documentation takes up to 30 days but you only have 30 days to file an appeal. The window of opportunity could close before documentation is ever received. 
    • There needs to be clearer, more encouraging, helpful explanation of the appeals process. 
    • MMEC recommends exploring best practices for appeals processes for commercial insurance companies.
  • MMEC shared Self Service Portal concerns.
    • Tabs in the SSP look like they can’t open but they do. MMEC recommends making this feature more obvious.
  • Coverage concerns
    • MMEC recommends that hearing aids, frequency of cleanings, and equipment have more coverage.
      • Recent audiology policy update, effective 4/1/24, addressing age, diagnoses, removal of PCP referral requirement, and more was shared with MMEC. Leadership shared with the MMEC that policy changes were made after surveying audiology providers.
    • Information about Non-Emergency Medical Transportation (NEMT) providers needs to be more easily accessible to members, promoted more, and easier to understand.
      • We will have content in the handbook and will consider an article for the E-Newsletter.
    • MMEC expressed concerns for providers experiencing difficulties with length of wait for reimbursements. They feel this deters providers from partnering with ND Medicaid. 
  • Do we want to request a guest speaker?
    • Out-of-State Coverage
    • Behavioral Health
    • Medicaid and BCBS Expansion
    • Recipient liability
    • Medicare and Medicaid dual coverage

Next Steps

• Reminder for next meeting
  • July 9, 2024 @ 9:30-11:320am
• Upcoming meetings
  • September 10, 2024
  • November 5, 2024

MMEC Meeting Minutes 5/7/24

Agenda

Welcome & Icebreaker

• Roll call
• Meet & Greet
• Icebreaker

Discussion

• Question for all: What is your biggest concern for Medicaid?
• Review Medicaid Member E-Newsletter
• Q&A
• Open Discussion
• Decisions

Next Steps

• Reminder for Next Meeting
• Annual Agenda

Minutes

Welcome & Icebreaker

• Meeting called to order at: 9:32am
• Meeting adjourned: 10:50am
• Roll call of committee members in attendance: 
  • Eldor Scheid
  • Allie Browning
  • Victoria Alexander
  • Kara Hanson
  • Jacqueline Frost
• Members Absent: 
  • Heather Skadsem
• Introduction and welcome to the first meeting
  • Meet & Greet
  • Icebreaker

Discussion

• Question for All: What is your biggest concern with Medicaid?
  • Eldor: The change from county representatives to state workers. When calling in, members do not get the same worker and notes are not summarizing the last call to save the member from repeating information. Appeal experience is not pleasant. Medicaid does not seem responsive. 
  • Kara: Information availability: What does Medicaid cover such as equipment? Increased clarity on covered and non-covered services. 
  • Victoria: The lack of services I am getting such as glasses options, dentist availability, etc. These are my basic needs that are not being met.  
  • Jacqueline: Medicaid is so limiting. The whole picture is not considered. Denials for out-of-state specialist are a large barrier. Specific equipment is not always covered.
  • Allison: The lack of dental, vision, and transportation. There is a lack of providers for transport. Client share is too high to work with.  
• Review E-News
  • Members will review January E-Newsletter and attend the next meeting with notes.
• Q&A
  • Is the website able to search just the Medicaid Member Handbook?
    • Jen to follow up with Communications department.
  • Can a chat box be developed for the website to offer live assistance with navigating the website and answer general Medicaid questions (alternative to calling and experiencing long wait times with call center)?
    • Jen to follow up with Communications department.
  • Can we program the HHS website so that if certain words are searched it will lead to the Medicaid Member Handbook?
    • Jen to follow up with Communications department.
  • How often does the Provider Directory get updated? What are the future plans for these documents with the PCCM program ending?
    • Jen to follow up.
• Open Discussion
  • What are our main focuses?
    • Navigating coverage
      • Increase coverage information
        • What is covered
        • When coverage is allowed
      • Specialist/guide/health care coach to assist members in understanding how to organize complex health care needs:
        • Specialty/complex health care needs: Out-of-state referrals, billing, referrals, covered services, and equipment, appeals, etc. 
        • Help from specialist could be by appointment, with notes, and ability for members to return to the same specialist
        • Initiated in welcome letter and Health Tracks initial contact.
    • Navigating website
      • Chat box for live assistance in website navigation or general Medicaid questions to avoid long wait times when calling into call centers
      • Finding providers, user friendly provider lists
      • Can our searches lead to the Medicaid Member Handbook based on frequently used words (find a dentist, coverage, etc.)?
    • Medicaid coverage 
      • Transportation
      • Reimbursement to driver per person not per ride
      • Coverage for glasses/vision to include transition (no line) bifocal lenses. Allow for Medicaid to cover set cost for frames/lenses and member to choose to pay for remaining cost of frames/lenses they desire. 
  • What are our current tasks?
    • Medicaid Member Handbook review
      • Details on finding a dentist, vision, etc. to include www.insurekidsnow.gov
        • Instructions to ask if provider is currently accepting Medicaid and taking new clients
        • Links to provider lists
    • Medicaid Member E-News review
      Find a person, with limited/no exposure to www.hhs.nd.gov to navigate website to Medicaid information and give honest feedback
• Decision
  • Current focus
    • Navigating coverage
    • Navigating website
    • Medicaid coverage expansion
  • Current tasks
    • Handbook review
    • E-News review
    • Website navigation testing

Next Steps

• Reminder for next meeting
  • May 7, 2024 @ 9:30-11:320a
• Annual agenda
  • March 5, 2024
  • May 7, 2024
  • July 9, 2024
  • September 10, 2024
  • November 5, 2024

MMEC Meeting Minutes 3/5/24

ND Medicaid values member and family participation in improving the Medicaid member experience. The Medicaid Member Engagement Committee (MMEC) is a way for members to share their lived experience, give input, and bring positive change to ND Medicaid.

The MMEC is designed to meet the following objectives: 

• Prioritize person and family centeredness, which means we respect and value individual strengths, preferences, and contributions, and work with members, not doing things to or for them.
• Provide opportunities for collaboration between ND Medicaid and members with the goal of improving member experience and the relationship between ND Medicaid and all members.
• Provide a way for ND Medicaid to test if programs, policies, and materials are working as designed and having the desired outcome.

Discussion and recommendations from the MMEC will help guide ND Medicaid and will be shared with the Medicaid Medical Advisory Committee, ND Medicaid Leadership, and ND Department of Health and Human Services Leadership. 

The MMEC will have 12 members. ND Medicaid seeks to have members with different backgrounds, geographical areas, and with different life experiences and situations represented on the MMEC. ND Medicaid encourages all Medicaid members interested in serving on the MMEC to apply. 

Who Should Apply

ND Medicaid encourages current Medicaid members, people who have had Medicaid within the last three (3) years or are caring for a Medicaid member to apply for the MMEC. 

Note: Medicaid Expansion members are not eligible to serve on the MMEC but can share their views on Medicaid Expansion with the Medicaid Expansion Member Advisory Committee. 

Medicaid is also different than Medicare. There are many people who have both Medicare and Medicaid, and we will welcome those members if they have experience with Medicaid. 

How to Join the MMEC

People applying to join the MMEC are called applicants. All applicants will apply to the MMEC by submitting an application. If you need help with the application, you can ask the Member Liaison for help by calling 701-328-8666 or emailing jsheppard@nd.gov 

Selecting a New Member to be on the MMEC

ND Medicaid will review applications and interview selected applicants to ensure membership is diverse and represents the ND Medicaid population.  Applicants will meet with the Member Liaison for a short interview. The Member Liaison will recommend applicants for the MMEC to the Medicaid Director. The Medicaid Director will appoint members to the MMEC.
LEARNING ABOUT THE MMEC
All new members of the MMEC will meet with the Member Liaison. The Member Liaison will review what to expect at MMEC meetings, show individuals how to use technology to participate in MMEC meetings, and go over recent topics discussed at MMEC meetings. 

Membership Terms

The time a member serves on the MMEC is call a term. Each member will serve a two (2)-year term. Terms cannot be served in a row. A member can serve up to two (2) terms. 

If a member wants to serve a second term, they will need to apply and will be evaluated alongside other applications. 

Medicaid Medical Advisory Committee Membership

The Medicaid Medical Advisory Committee (MMAC) is made of members who are representatives of state or local consumer advocacy groups, clinical providers, representatives of managed care plans, legislators, tribal leaders, and members. 

This committee reviews recommended policy changes and state plan amendments, discusses Medicaid initiatives and activities, and reviews quality, access, and expenditures.

Federal regulation requires that a portion of the MMAC be made of members serving on the MMEC. 

Medicaid Member Engagement Committee Members serving on the MMAC shall serve a term of two (2) years from the date of appointment unless they resign, or their membership is terminated. Only active MMEC members may fill the five (5) designated MMEC seats. Former MMEC members may apply to serve a three (3) year MMAC term as a non- MMEC Medicaid member.

Chairperson

A chairperson may be chosen from current MMEC members during their two-year term. The chairperson will: 

• Help the Member Liaison organize and plan meetings,
• Find guests to share information, and
• Run the meeting. 

Resignation and Removal

Resignation is when a member feels they need to leave the MMEC before their term is ending. If a member cannot be on the MMEC anymore, a seat will be opened.  

Members may be removed from their seat on the MMEC for good cause. Examples of good cause are: 

• Excessive absences from MMEC meetings.
• Misconduct during MMEC meetings.

Benefits

We value our MMEC members! While you are on the committee:

• Medical Services offers members direct access to our resources and staff while they serve their term. Please contact the Member Liaison to learn more.

MMEC members that fulfill their commitment:

• Will be able to ask for a letter of recommendation from our Member Liaison
• Can use the Member Liaison as a professional reference. 

These are helpful when you are applying for a job or other committee-like work.

Release of Information

ND Medicaid may request that members sign a release allowing a picture, the name, and/or basic information about the member to be published on the www.hhs.nd.gov website.

The MMEC will meet online every other month. Meetings will be held on Teams with an option for individuals to join the meeting by phone. Meetings will last no more than two (2) hours.

Additional meetings will be held as needed when requested by committee members.

ND Medicaid will publish a yearly schedule for MMEC meetings. The meeting schedule will be posted on the MMEC website. 

Attendance

ND Medicaid encourages members to attend every meeting to the best of their ability. ND Medicaid asks each MMEC member to commit to attending at least four (4) meetings a year. 

If a MMEC member misses more than three (3) meetings per calendar year, ND Medicaid may work with the member to determine if they are able to participate or if another Medicaid member should attend the MMEC in their place.

MMEC members will attend quarterly MMAC meetings to observe, give member-based input, and share MMEC progress and/or concerns. 

Meeting Minutes

Meeting minutes are notes of what was talked about at a meeting. Minutes will be taken at every meeting. ND Medicaid will summarize topics, suggestions, and follow up on progress. Minutes will be posted on the MMEC website. 

Disability and Other Accommodations

ND Medicaid will assist members with accommodations such as American Sign Language (ASL) translation, captioning, and caregiver participation for members with barriers. ND Medicaid encourages members to tell the Member Liaison about any assistance they will need to attend and participate in the MMEC meetings. 

ND Medicaid will also make accommodations for written or recorded materials presented at meetings such as translation, captions, descriptions of pictures, etc.

Conflict of Interest

The MMEC is meant to improve the ND Medicaid experience for the entire member body. MMEC members should not benefit from their membership beyond the benefits gained by all ND Medicaid members. A conflict of interest is:

• A circumstance where a member, entity, or individual closely affiliated with the member could financially benefit from the member’s participation in or connection to the MMEC. 
• A situation where a member cannot separate their personal agenda from their service on the MMEC.
• A member’s personal relationships, activities, or interests that cause conflicting goals, impair a member’s participation, or inappropriately influence their decisions or actions.

Time will be held at every meeting to allow members to express potential conflicts of interest. When a potential conflict is expressed, the remaining, present members will determine whether the situation is to be considered a conflict of interest. A conflict of interest exists if the conflicted member’s participation, voting, or further actions related to the matter result in that member benefiting or being impaired as described above.

If the remaining, present members find there is a conflict of interest, the conflicted member should excuse themself from conversations, voting, and further actions on matters related to the conflict. If the remaining, present members find the potential conflict of interest not a conflict, the potentially conflicted member may resume regular participation.

Disclosures of conflicts will be recorded in the meeting minutes. 

ND Medicaid values the feedback of Medicaid members and their families. The MMEC asks members to share their lived experiences with each other and others attending MMEC meetings and give all members a chance to be heard. ND Medicaid asks members of the MMEC to act in good faith with each other and agree to a set of guidelines for how the MMEC will interact with each other. This includes being honest and not doing things that will harm the MMEC. It also includes behavior outside of meetings. Expectations include:

• Members should try to attend and actively participate in all meetings. If members cannot attend a meeting, they are requested to advise the ND Medicaid Member Liaison. After missing a meeting, the member should plan to meet with Member Liaison to go over what happened at the meeting.
• Members agree to be respectful of other MMEC members, ND Medicaid staff, and other presenters. They will listen to each other and seek to understand the other’s perspectives, even if they disagree.
• Members agree to make every effort to share their feedback and experience and bring forward any concerns. 
• Members agree to refrain from personal attacks, purposefully harming the MMEC, and publicly criticizing or mis-stating information shared by other MMEC members during the meeting.
• Any written communications, including emails, blogs, and other social networking media (Ex. Facebook, Instagram), will follow these same guidelines and will maintain a respectful tone even if highlighting different opinions.

Member Liaison
Jen Sheppard
jsheppard@nd.gov | 701-328-8666

Alternative Contact
Mandy Dendy
mrdendy@nd.gov

The MMEC Guidelines inform members of this committee's purpose, how our meetings are held, and what membership looks like.