North Dakota Supports Caregivers to Serve Rural Populations
/in Policy North Dakota Blogs, Featured News Home Chronic and Complex Populations, The RAISE Family Caregiver Resource and Dissemination Center /by Luke Pluta-EhlersState Approaches to Expanding PACE
/in Policy California, Florida, Kansas, Michigan, North Dakota, Pennsylvania Blogs, Featured News Home Chronic and Complex Populations /by Neva KayeHow North Dakota Uses 1915(i) to Provide Supportive Services to People with Behavioral Health Conditions in Rural Areas
/in Behavioral/Mental Health and SUD North Dakota Featured News Home, Reports Behavioral/Mental Health and SUD, Safety Net Providers and Rural Health /by Neva KayeFive Trailblazing States Consider Legislation to Capture Big Rx Savings Using Canadian Reference Rates
/in Prescription Drug Pricing Hawaii, Maine, North Dakota, Oklahoma, Rhode Island Blogs, Featured News Home Model Legislation, Prescription Drug Pricing, State Rx Legislative Action /by Jennifer Reck and Trish RileyBurdened by high US drug prices that average 218 percent more than in Canada, innovative states across the country are exploring a range of approaches to give their residents the same access to affordable drugs Canadians have. To date, six leading states have passed laws that enable them to import drugs from Canada pending federal approval of their programs. Now, a second set of trailblazing states are exploring an alternative approach that does not require federal approval – importing Canadian drug prices.
Lawmakers in five states (HI, ME, OK, ND, and RI) have introduced or pre-filed bills based on the National Academy for State Health Policy’s (NASHP) model legislation to establish international reference rates using Canadian pricing.
Establishing payment rates for hospitals’ and providers’ services is common to ensure access to affordable care. The NASHP model extends that practice to prescription drugs, giving states a powerful tool to limit what payers within a state will pay, without running afoul of patent law by setting prices.
What is international reference rate legislation?
International reference rate legislation authorizes a state’s department of insurance to establish international reference rates for the costliest drugs in that state. The department determines the reference rates based on those drugs’ prices in Canada’s four largest provinces. The lowest price would become the legal upper payment limit for those drugs for participating purchasers in the state.
A savings analysis NASHP facilitated for one state considering this legislative approach, showed annual savings of more than $32 million for just 35 drugs purchased by state employees alone. States are proposing setting reference rates for up to 250 drugs for all commercial payers, including Medicare advantage plans (Medicaid and traditional Medicare would be excluded), so total savings would far exceed that initial estimate.
Under the model legislation, any savings generated must be shared with consumers through mechanisms left to the discretion of a state. Options may vary by payer, ranging from reducing premiums for commercial payers, maintaining or expanding access to Medicaid services, and avoiding tax increases for public payers.
Oklahoma state Sen. Greg McCortney identified the potential for savings as key. “I do not believe that we can fix our broken health care system until we address the cost of care,” he said. “This bill, once fully implemented, should reduce insurance premiums for every person in the state by hundreds of dollars each year.”
The model law’s implementation process is designed to be easy for a state to administer and does not require costly infrastructure at a time when states are burdened by the pandemic and budgetary restraints. As a proxy for all commercial payers, the bill uses a state’s employee health plan to identify the costliest 250 drugs, determined by drug price times utilization.
- The state employee health plan shares the list of 250 drugs with the Department of Insurance.
- The department then establishes references rates by comparing publicly available data on drug prices in Canada’s four most populous provinces. The lowest price becomes the reference rate for payers within the state.
- No commercial payer could pay more than the reference price established by the state’s department of insurance, and a manufacturer that withdrew a drug or refused to negotiate in good faith would be subject to significant penalties.
As states move forward in their legislative sessions, states are adapting NASHP’s reference rate model and making it their own. They’re exploring variations in the roles their agencies would play, as well as possibly limiting the number of referenced drugs to a smaller group that would have maximum impact.
North Dakota – Medical Homes
/in Policy North Dakota /by NASHPWe have no information on medical home activity that meets the following criteria: (1) program implementation (or major expansion or improvement) in 2006 or later; (2) Medicaid or CHIP agency participation (not necessarily leadership); (3) explicitly intended to advance medical homes for Medicaid or CHIP participants; and (4) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
Last Updated: April 2014
North Dakota
/in Policy North Dakota /by NASHPIn 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.”
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| Initiatives to Improve Access |
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| 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.
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| 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.
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| 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.
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| 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.
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North Dakota
/in Policy North Dakota /by NASHPNASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.
Last updated: October 2012
North Dakota
/in Policy North Dakota /by EBPHIT_AdminNo HIE Strategic Plan available yet.
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For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
