Medical Services Division

1. Medical Services Division Administration of: Medicaid Home and Community-Based Services State Funded and Medicaid Waivers SCHIP Developmental Disability Grants

2. Applying for Coverage Forms are available on the web. (www.nd.gov/dhs/) Medicaid – County Offices SCHIP – County Offices or State Office Joint Application for Children’s Coverage Medicaid, SCHIP and Caring for Children

3. Eligibility Periods Medicaid Varies by Category – 2007 Legislature appropriated funds to allow for 12-month, continuous eligibility for children enrolled in Medicaid SCHIP 12-month, continuous eligibility

4. SB 2012 – DHS Appropriation State Children’s Health Insurance Program Funding to Sustain Outreach Efforts Specific expectations of contractor to propose and implement an outreach program for the Indian Reservations in North Dakota.

5. Transportation Enroll individuals to provide transportation for Medicaid clients to and from Medical appointments. Do not enroll clients for Medicaid transportation.

6. Mental Health Services Licensed (Clinical) Psychologists Licensed Independent Clinical Social Workers Occupational Therapists Regional Human Service Centers Inpatient Psych – Under 21 Targeted Case Management

7. Home and Community-Based Services • Personal Care Services in State Plan • Targeted Case Management • PACE – Implementation in 2008 • Waivers • Traumatic Brain Injury • Home and Community-Based Waiver • Technology Dependent • Late 2007/Early 2008 – Medically Fragile Children’s Waiver • Developmental Disabilities • HCBS • Self-Directed Supports – Children and Adults

8. SB 2012 –DHS Appropriation Added services to the Home and Community-Based Services Waiver • Nurse Management • Home Delivered Meals • Family Home Care for Spouses • Enhanced Payment for Adult Family Foster Care

9. Reimbursement - Pharmacy Previous – Encounter Rate No Prospective or Retrospective Drug Utilization Information Hinder Disease Management Efforts New Process – Bill like Pharmacy providers Able to completed DUR and have complete medication profiles for DM efforts

10. Legislation – Dental Access HB 1246 – Provided additional funds to enhance the dental fee schedule for children’s services. HB 1293 – Allows practitioners, other than dentists, to apply fluoride varnish.

11. 2007 Legislative -Eligibility Expansions HB 1463 – would expand Medicaid and SCHIP eligibility. (This bill hinges on federal changes during SCHIP reauthorization.) SB 2326 – authorizes a new Medicaid eligibility category – Buy In for Children.

12. Drug Use Review HB 1422 – Directs the Department to review each drug in the Mental Health, Cancer and HIV/AIDS classes during the 07-08 Interim.

13. Other Initiatives • Money Follows the Person • Medicaid Transformation Grant • Modernizing Medicaid – an effort of the state’s Medical Advisory Committee • Disease Management

14. Disease Management • Implementing a disease management program (a pre-paid ambulatory health plan [PAHP]) for Recipients with specific chronic conditions • The State Plan and Waiver have been approved by CMS. Waiting for CMS approval of contract. • Recipients with asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes can participate

15. Disease Management (cont.) • September 1, 2007 Implementation • SDM will hire local nurses on a regional basis to: • Provide care management and health education for Recipients with these conditions • Inform providers about the program and clinical practice guidelines for each disease • Operate a telephone health information line that is available to program Recipients 24 hours per day, 7 days per week

16. North Dakota Contact Information: Medical Services Division Dept of Human Services #325 600 E Boulevard Ave Bismarck, ND 58505-0250 Telephone: 1-800-755-2604 www.nd.gov/dhs/