North Dakota

In North Dakota:
  • Most Medicaid services are delivered through a primary care case management (PCCM) program, which serves as the Managed Care Program within the state. The PCCM program requires that most beneficiaries select a primary care provider (PCP) and requires all non-emergency based services to be received from the PCP, with other services (i.e. specialty or hospital services) available with a referral from the PCP. North Dakota Medicaid also runs a prepaid ambulatory health plan (PAHP) called Experience HealthND, which is a disease management program for chronic conditions including: asthma, chronic obstructive pulmonary disease (COPD), diabetes, and heart failure.
  • There were a total of 66,698 beneficiaries enrolled in North Dakota’s Medicaid program as of July 2011. Of these 42,423 were enrolled in the PCCM program. Another 3,196 were enrolled in Experience HealthND. North Dakota Medicaid covers a range of services including mental health and dental services.
 
As of 2013, 51,168 individuals were eligible for through Health Tracks, North Dakota’s Medicaid benefit for children and adolescents (also known at the Early and Periodic Screening, Diagnostic, and Treatment benefit, or EPSDT). According to CMS data from 2013, North Dakota achieved an EPSDT screening ratio of 58% and a participation ratio of 46%. 14,141 children received dental services of any kind, with 12,563 receiving preventive dental services.
 
Last updated June 2014
 
Medical Necessity
North Dakota Administrative Code 75-02-02-03.2 states:
 
“‘Medically necessary’ includes only medical or remedial services or supplies required for treatment of illness, injury, diseased condition, or impairment; consistent with the patient’s diagnosis or symptoms; appropriate according to generally accepted standards of medical practice; not provided only as a convenience to the patient or provider; not investigational, experimental, or unproven; clinically appropriate in terms of scope, duration, intensity, and site; and provided at the most appropriate level of service that is safe and effective.”
 
North Dakota’s Medicaid Provider Manual lists Health Tracks screening services, and then notes that Health Tracks services also include:
 
“Other necessary health care to provide diagnosis and treatment to correct or improve defects, physical and mental illnesses and conditions discovered by the screening services.”
Initiatives to Improve Access
 
Reporting & Data Collection
Providers are encouraged to use the MCH/Health Tracks Pediatric Assessment Form to meet documentation requirements. These requirements can also be met using an internal form as long as the information contains all of the components listed in the Health Tracks Service Requirements. Documentation requirements include each component of a well-child screen under the EPSDT benefit.
Behavioral Health
Children receive developmental and mental health screens as a part of Health Tracks visits. These visits also include maternal depression screening for mothers of newborns. Health Tracks will also pay for mental, developmental, and behavioral health services as deemed medically necessary. 
 
North Dakota Medicaid, in partnership with the North Dakota Department of Health, offers an online training course to help professionals recognize mental health problems affecting children from birth to age 21. The course includes a series of videos and links to various screening tools including the Ages and Stages Questionnaire and the Pediatric Symptom Checklist. North Dakota also maintains a list of recommended mental health screening tools that contains these screening tools as well as several others.
Support to Providers and Families  
Care Coordination
North Dakota offers Targeted Case Management services for pregnant women eligible for North Dakota Medicaid and their children, up to six months of age. These services include arranging appointments and linking participants to services such as prenatal education and parenting resources.    
 
North Dakota Medicaid also runs the Experience HealthND Medicaid Health Management Program for Medicaid recipients with chronic conditions including: asthma, COPD, diabetes, and heart failure. In this program beneficiaries work with Registered Nurse Care Managers to assist patients with managing their health conditions. 
Oral Health
Health Tracks provides dental services including relief of pain and infections, restoration of teeth and maintenance of dental health. Health Tracks also covers orthodontia services (braces) and additional dental services as deemed medically necessary.