North Dakota Department of Health

The meeting focused on several key agenda items, including the introduction of new members. Major discussions covered State Plan Amendments for Behavioral Health Rehabilitative Services, which included enhanced guidelines and the addition of annual, soft service limitations, anticipated to affect approximately 1.7% of members receiving these services. Another amendment involved expanding the definition of 'Other Licensed Providers' to include Licensed Master Social Workers. Updates for School-Based Services proposed allowing LPNs to bill CPT code T1000 under RN supervision. The committee also reviewed updates to the Medicaid Policy Update Process, detailing how coverage changes are communicated and the public comment procedure, and discussed the annual review process for coverage policies. Finally, an education topic presented an overview of the Rural Health Transformation Program (RHTP), covering enactment, focus areas, allowable uses of funds, and the timeline for distribution and awards.

The meeting covered several key discussions. Updates were provided regarding State Plan Amendments (SPA) for Community Health Worker (CHW) and Community Paramedic (CP) Services, including the posting schedule for public comment in August 2025 and certification timelines beginning October 1, 2025. Amendments to the HCBS Medicaid 1915(c) Waiver were discussed, noting the public comment period closing August 21, 2025, which includes changes to service rates and monitoring protocols. The 1915(c) Traditional IID/DD HCBS Waiver amendment submission is planned for January 1, 2026, intending to introduce the Host Home service for children awaiting reunification. An educational topic detailed the anticipated impacts of the One Big Beautiful Bill Act, signed July 4, 2025, covering timelines for compliance regarding duplicate enrollment checks, eligibility frequency increases, changes to 'Qualified Alien' definitions, retroactive coverage reduction, and implementation of work/community engagement requirements by late 2026/2027. Public comments included requests for updates on cross-disability waivers, telehealth availability, and accessibility of the coverage renewal process.

The consultation covered several key updates and discussions related to North Dakota Medicaid and Tribal health initiatives. Public Health Division updates included the availability of an online Health Equity Training series and the status of a Tribal Health Liaison position. Indian Affairs provided updates on the recent ND Indian Affairs Commission meeting and the need for Tribal representatives on Task Forces. Medical Services introduced the new Tribal Liaison, Monique Runnels, and discussed upcoming Member Engagement Committee recruitment. Updates were provided on Medicaid Renewals Dashboards and the redesign of the economic assistance application process. Action items focused on Tribal enrollment in Medicaid, potentially requiring legislative activity, and funding for Navigators. Further follow-up items included Medicaid preparing follow-up education/training and scheduling a dedicated meeting regarding Presumptive Eligibility & Tribal Enrollment. Updates on State Plan Amendments (SPAs) included coverage for mandatory adult vaccinations. Waiver updates covered the Autism, Medically Fragile, and Children's Hospice Waivers, detailing proposed changes such as slot increases and service additions. The Developmental Disability (DD) Waiver renewal discussed changes including increasing limits for environmental modifications. A significant discussion occurred regarding the IMD Exclusion, where Tribes inquired about the process (SFN 905 form) to request ND Medicaid pursue a Section 1115 SUD demonstration waiver. Policy updates addressed manual revisions, the addition of a Preventive Health Services chapter, changes to MAT terminology (to MOUD), and the sunsetting of the PCCM program. Finally, updates were provided on the Community Health Worker Task Force formation and Tribal Care Coordination resources, which will remain a standing agenda item.

The meeting covered several Public Health division updates, including a syphilis case update, immunization reminders, and a health alert for a pertussis case increase. Medical Services updates focused on Medicaid unwinding progress and the initiation of a new Cross Disability Advisory Council. Key discussions involved updates on State Plan Amendments (SPA) and Waivers, particularly the 1915(i) State Plan Amendment regarding home and community-based services for behavioral health conditions, detailing eligibility criteria and proposed service changes pending CMS approval. Updates were provided on the HCBS waiver, the Developmental Disability Traditional Waiver (including an increased environmental modifications limit), and the Autism waiver (noting an increase in slots and age limit). Policy updates addressed the use of SFN-905 for new Medicaid coverage requests and the upcoming sunset of the Primary Care Case Management (PCCM) Program on December 31, 2023. Member engagement initiatives included updates on the Medicaid Member Engagement Committee applications and ongoing work regarding Tribal Care Coordination Fund reporting and guidance. The Community Health Worker (CHW) Task Force review noted an upcoming special meeting. Finally, action items addressed follow-up regarding Presumptive Eligibility, including focus groups for Medicaid 101 materials, and the status of the IMD Waiver (stating Medicaid will not pursue the section 1115 demonstration at this time, prioritizing home and community-based treatment through the SUD Voucher Program).

The meeting focused on several updates and consultations regarding Tribal Health and Medicaid. Key discussion points included updates on the Multi-Partner Health Collaborative, ongoing efforts to secure DUAs with Tribal Nations, and updates on State Plan Amendments (SPAs) and Waivers. Specific attention was given to upcoming SPAs effective January 2025 concerning Tribal Consultation and CHR Targeted Case Management, including proposed changes to access services, provider qualifications, and supervision requirements, developed with tribal workgroup input. Updates were also provided on the HCBS Waiver Amendment for Traditional IID/DD Services, changes to the 1915(i) Behavioral Health Supports program, and progress on the CHW Taskforce, which is finalizing administrative rules for certification and regulation. Other significant topics included discussions on the ND Medicaid 2025-27 Biennium Priorities & Budget, updates on Tribal Care Coordination fund distribution policies, the process for nominating a MMAC Tribal Representative, and progress in defining Traditional Healing and determining whether to pursue an SPA for covering related services.