Welcome to the North Dakota Medicaid Provider newsletter. We hope this newsletter provides you with important and beneficial information about the North Dakota Medicaid Program. If you have any suggestions for future articles, please send your ideas to [email protected].
In this edition, you can learn about:
- Expanded postpartum coverage for qualifying new moms,
- Newly redesigned ND Medicaid ID cards,
- Funding opportunities to expand in-home and community-based care services for people with disabilities, and
- A change to maternal depression screening coding guidelines, and more.
Thank you for being a North Dakota Medicaid provider and serving Medicaid members.
ND Medicaid expands postpartum coverage for new moms
To help improve maternal health and coverage stability, ND Medicaid is expanding its postpartum coverage from 60 days to 12 months for eligible new moms starting Jan. 1, 2023.
This will provide 12 months of continuous postpartum coverage to eligible ND Medicaid members and access to full Medicaid benefits such as:
- Healthy mom checkups after birth,
- Ongoing care for diabetes, high blood pressure and other health needs,
- Dental care,
- Behavioral health services,
- Preventative care services like mammograms and cervical screens,
- Chiropractic care,
- Physical therapy, and
- Family planning services.
We need your help in spreading the news
If you work with Medicaid members who are pregnant, encourage them to tell their human service zone office right way that they are pregnant, so they can receive this coverage.
Timing is so important. They need to do this while pregnant in order to receive the expanded coverage. This must be done no matter which Medicaid program or category the member qualifies for.
This expanded coverage is made possible by a provision in the American Rescue Plan Act of 2021.
Why is this important?
The expanded coverage will help address North Dakota’s maternal health needs. Data from the Centers for Medicare and Medicaid Services shows that more than half of pregnancy-related deaths occur in the 12-month postpartum period. This can be prevented.
Also, expanded coverage is associated with better outcomes for infants. Research shows that women who have health coverage have children with more connection to the health care system. For example, the likelihood of well-child visits may increase.
Another benefit is women will have additional time to access behavioral health services to address postpartum depression and other conditions that may detract from their ability to care for an infant and other children.
ND Medicaid ID cards get a new look
ND Medicaid is excited to unveil its new member ID cards.
All newly-eligible members will receive the teal card with the North Dakota Be Legendry logo on it.
In the coming months, all current ND Medicaid members will receive the new card, which replaces the old gold-colored ID cards.
Grant funding is available for providers interested in expanding in-home and community-based care services for people with disabilities
North Dakota’s Health and Human Services agency is offering more than $2 million in provider development grants to entities that want to develop or expand in-home and community-based (HCBS) services that help North Dakotans with disabilities live more independently in the community.
Who should apply?
Qualified service provider agencies, providers of developmental disability and autism spectrum disorder services funded through Medicaid or state HCBS programs, or Medicaid 1915(i) state plan amendment service providers can apply for individual grants of $50,000 each.
How can the funds be used?
- Staff training and professional development,
- Marketing,
- Technology costs,
- Furniture and equipment,
- General operating costs,
- Minor building renovations that may be needed to establish a new HCBS agency or expand services in an existing agency, or
- Consulting services to help assess and improve business operations.
To Apply
Providers can learn more and find applications and the budget template online on the Health and Human Services website.
The deadline to apply is Oct. 17, 2022.
Maternal Depression Screening Coding Guidelines updated to align with American Academy of Pediatrics
Effective Oct. 1, 2022, ND Medicaid Coding Guideline for Maternal Depression Screening limits will be updated to allow the mother of a child under the age of one to receive four maternal depression screenings. This change aligns with the American Academy of Pediatric (AAP) recommendations.
Studies show that postpartum depression leads to increased costs of medical care, inappropriate medical treatment of the infant, discontinuation of breastfeeding, family dysfunction and an increased risk of abuse and neglect.
The AAP recommends pediatric medical homes integrate postpartum depression surveillance and screening at the one, two, four and six month well-child visits and use community resources for the further assessment and treatment of a mother with depression.
Revised Blood Lead Reference Value
The Centers for Disease Control and Prevention (CDC) recommends testing blood for lead exposure. All children are considered at risk and should be screened for lead toxicity because early identification is key to reducing the long-term effects of lead exposure.
ND Medicaid Health Tracks/Well-Child benefit requires that all children who qualify for ND Medicaid have a blood lead test completed at 12 months and 24 months of age. Children who were not checked for lead toxicity at these ages, should be screened between three and six years of age.
Health care providers should use either a capillary or venous sample for the initial blood lead level. If the capillary results are equal to or greater than 3.5 ug/dl, a venous sample should be collected. All blood lead level results are included in the mandatory reportable conditions per ND Administrative Code 33-06-01-01 Reportable Conditions.
The lead toxicity screening questionnaire (SFN 59322) can be utilized for children screened at ages outside the ranges noted above.
Additional information on blood lead levels is available at CDCs website.
Provider Updates
Effective Jan. 1, 2023, ND Medicaid will require a valid HCPCS code for revenue code 250 on all outpatient services. A NDC must also be submitted if the HCPC code requires it.
Ambulance Providers: Effective for claims processed on and after April 1, 2021, you must submit CPT modifier 76 with ambulance transports (HCPCS codes A0425-A0999) to indicate when a second trip occurred on the same date of service.
Effective Oct.1, ND Medicaid will cover Omnipod DASH and Omnipod 5 Tubeless Automated Insulin Delivery Systems. These will be covered through pharmacy point-of-sale billing for ND Medicaid members with Type 1 diabetes who are under the age of 21. Providers can refer to the Preferred Drug List located at ND Medicaid prior authorization website for forms, clinical criteria and frequently asked questions regarding coverage and billing.
Effective Sept. 7, to better align Synagis coverage with respiratory syncytial virus (RSV) outbreaks as reported to the Centers of Disease Control and Prevention, the RSV season will be identified using data reported by the National Respiratory and Enteric Virus Surveillance System (NREVSS) Midwest Region.
The RSV season onset will be defined as the first of two consecutive weeks when percentage of polymerase chain reaction (PCR) tests positive for RSV is greater than 3%.
Season offset will be defined as the last of two consecutive weeks when percentage of positive PCR tests for RSV is less than 3%.
What to do next - prior authorization requests
Up to five weight-based doses will be authorized within six months from the RSV season onset. No further prior authorization requests (PA) will be approved following the season offset. The PA approval letter will include the number of authorized units and the duration of the approval.
The current season started on Aug. 27, 2022.
