Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

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Products and Devices

Transportation Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: North Dakota (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Fee for service	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes				Cost based payment	CN & MN
Federally Qualified Health Center Services
Yes	$3/visit			Prospective cost based rate/visit for medical services, cost based payment for dental services	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$75/admission	Transfers to LTC hospitals	30 days for rehab, 21 days for psych	Prospective payment/discharge using DRG and peer groups, prospective per diem for psych and rehab services, prospective percentage of charge payment for long-stay hospitals, cost based payment for critical access hospitals	CN & MN
Outpatient Hospital Services
Yes	$6/non-emergency visit in ER		30 SP visits/year included in limits for other providers of therapy services	Fixed percentage of charge	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes				Fee for service	CN & MN
Rural Health Clinic Services
Yes	$3/visit			Prospective cost based rate/visit	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service at 75% of physician fee	CN & MN
Chiropractor Services
Yes	$1/visit		12 manipulation visits/year, 2 x-rays/year	Fee for service	CN & MN
Dental Services
Yes	$2/visit	Specified services		Fee for service	CN & MN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes	$2/visit			Fee for service	CN & MN
Nurse Midwife Services
Yes	$2/visit			Fee for service at 85% of physician fee	CN & MN
Nurse Practitioner Services
Yes	$2/visit			Fee for service at 75% of physician fee	CN & MN
Optometrist Services
Yes	$2/visit		1 refractive exam/3 years	Fee for service	CN & MN
Physician Services
Yes	$2/visit		40 psychotherapy visits/year	Fee for service	CN & MN
Podiatrist Services
Yes	$3/visit			Fee for service	CN & MN
Psychologist Services
Yes	$2/visit		40 psychotherapy visits/year	Fee for service	CN & MN
Prescription Drugs
Prescription Drugs
Yes	$3/brand Rx		Adult vitamins limited to pregnancy supplements, smoking cessation products limited	AWP-10% or WAC+12.5%, plus $4.60 dispensing fee for brand Rx and $5.60 for generic Rx	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes	$2/visit		1 evaluation/year, 20 therapy visits/year	Fee for service	CN & MN
Physical Therapy Services
Yes	$2/visit		15 visits/year	Fee for service	CN & MN
Services for Speech, Hearing and Language Disorders
Yes	$1/speech pathology visit, $2/audiological evaluation		1 speech evaluation/year, 30 speech therapy visits/year	Fee for service	CN & MN
Products and Devices
Dentures
Yes			1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years	Fee for service	CN & MN
Eyeglasses
Yes			1 pair/3 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility	Fee for service for eyeglass frames, acquisition cost for lenses	CN & MN
Hearing Aids
Yes	$3/hearing aid		1 hearing aid/5 years	Fee for service	CN & MN
Medical Equipment and Supplies
Yes		Med equipment or med supply items costing more than $500		Fee for service	CN & MN
Prosthetic and Orthotic Devices
Yes		Services or items costing more than $500		Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes				See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes				Fee for service	CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN & MN
Targeted Case Management
Yes				Fee for service	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes			Prospective cost based rate per visit	CN & MN
Hospice Care
Yes			Prospective rates based on Medicare methodology	CN & MN
Personal Care Services
Yes	Yes	240 hours/month	Fee for service	CN & MN
Private Duty Nursing Services
Yes			Fee for service	CN & MN
Program of All-Inclusive Care for the Elderly
Yes			Capitated paymentt5	CN & MN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		28 therapeutic leave days/year	Cost based per diem, with limits	CN & MN
Inpatient Psychiatric Services, under age 21
Yes			Prospective cost based per diem for private hospitals, cost based payment for state-owned facilities	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes		15 hosp leave days/hospitalization, 28 therapeutic leave days/year	Cost based payment	CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		15 hosp leave days/hospitalization, 24 therapeutic leave days/year	Prospective per diem based on cost, acuity adjusted, with limits	CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 225 percent of the federal poverty level (FPL). Beneficiaries in this group are required to pay an enrollment fee of $100 and a monthly premium equal to 5 percent of their gross countable income. They receive the same benefits as other Medicaid beneficiaries and are subject to the same copayment requirements. Any identified copayment requirements are also applicable to beneficiaries dually eligible for Medicare and Medicaid unless they are institutionalized.