Title 50, Public Welfare

The department may not require prior authorization, additional documentation not required by Medicare, or additional prescription requirements of durable medical equipment and supplies in order to process a claim for Medicaid-eligible individuals who are also eligible for Medicar…

Within the limits of legislative appropriations, medical assistance may be paid for any person who either has income and resources insufficient to meet the costs of necessary medical care and services or is eligible for or receiving financial assistance under chapter 50-09 or tit…

1. Each applicant or recipient of benefits under this chapter must be deemed to have assigned, to the department, any right of recovery the applicant or recipient may have for medical costs incurred under this chapter not exceeding the amount of funds expended by the department f…

For purposes of determining the treatment of income and the application of income to the cost of care for medical assistance eligibility for an individual screened as requiring nursing care services, and who is receiving home and community-based services or nursing care services,…

In determining eligibility for medical assistance applicants and recipients, the department shall establish a community spouse resource allowance equal to the maximum community spouse resource allowance as provided by 42 U.S.C. 1396r-5(f)(2). This section applies to a community s…

1. In determining eligibility for medical assistance, the department may not consider as an available resource any pre-need funeral service contracts, prepayments, or deposits to a fund which are placed in an irrevocable itemized funeral contract designated by the applicant or re…

The department may not consider, as an available asset for purposes of determining eligibility for benefits under this chapter, income and resources set aside by a blind or disabled person as part of a plan to achieve self-support, if the plan has been approved by the social secu…

1. An individual who secures and maintains insurance that covers the cost of substantially all necessary medical care, including necessary care in a nursing home and necessary care for an individual who qualifies for admission to a nursing home but receives care elsewhere, for at…

1. The department shall provide medical assistance benefits to otherwise eligible persons who are medically needy persons who have countable income that does not exceed an amount determined under subsection 2. 2. The department shall establish an income level for medically needy …

The department shall establish and implement a buyin program to provide medical assistance to an individual who, except for substantial gainful activity, meets the definition of disabled under the supplemental security income program under title XVI of the federal Social Security…

1. For purposes of this section, "annuity" means a policy, certificate, contract, or other arrangement between two or more parties under which one party pays money or other valuable consideration to the other party in return for the right to receive payments in the future. 2. The…

In the administration of the medical assistance program, the department or a human service zone shall investigate and record the circumstances of each applicant or recipient of assistance, in order to ascertain the facts supporting the application, or the granting of assistance, …

1. In the investigation of applications under the provisions of this chapter, the human service zones, the department, and the officials and employees of such agencies charged with the administration and enforcement of this chapter may: a. Conduct examinations; b. Require the att…

1. When the department determines a criminal history record check is appropriate, a provider applicant, a provider, or an individual with a five percent or more direct or indirect ownership interest in the provider applicant or provider shall secure, from any agency authorized to…

The department may adopt rules and regulations as necessary to qualify for any federal funds available under this chapter.

The effective date of this chapter is the date on which federal funds become available for the purposes and program outlined herein.

1. On the death of any recipient of medical assistance who was a resident of a nursing facility, intermediate care facility for individuals with intellectual disabilities, or other medical institution and with respect to whom the department determined that resident reasonably was…

The statute of limitations does not run against claims of the state of North Dakota for repayment of medical assistance provided under this chapter.

Within the limits of legislative appropriations, the department shall provide medical assistance to eligible recipients for services provided by psychologists licensed under chapter 43-32.

Notwithstanding section 50-24.1-34, expenditures required under this chapter are the responsibility of the federal government or the state of North Dakota.

Medical assistance coverage must include prehospital emergency medical services benefits in the case of a medical condition that manifests itself by symptoms of sufficient severity which may include severe pain and which a prudent layperson who possesses an average knowledge of h…

1. Medical assistance coverage must include reimbursement of ambulance services for responding to calls to assist covered individuals which do not result in transport. 2. For purposes of classifying ambulance services under this section: a. An emergency response is one that at th…

Medical assistance coverage, including Medicaid Expansion, must include coverage of a continuous glucose monitoring device for a covered individual.

The department may provide medical assistance for individuals screened and found to have breast or cervical cancer in accordance with the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000 [Pub. L. 106-354; 114 Stat. 1381; 42 U.S.C. 1396a et seq.]. The depart…

1. The department shall implement personal care services. 2. The department may implement residential habilitation and community support services in a residential setting or private residence that would allow for the delegation of administration of medication by an employee of a …

Any aged or disabled individual who is eligible for home and community-based living must be allowed to choose, from among all service options available, the type of service that best meets that individual's needs. To the extent permitted by any applicable waiver, the individual's…

An individual is not ineligible for medical assistance if application of disqualifying transfer provisions would deprive the individual of nursing care and services and the individual makes a satisfactory showing that: 1. For periods after the return, all income or assets constit…

1. For purposes of this section: a. "Denial of payment" means that the department has denied payment for a medical assistance claim or reduced the level of service payment for a service provided to an individual who was an eligible medical assistance recipient at the time the ser…

The department shall administer Medicaid waivers to provide in-home services to children with extraordinary medical needs and to children diagnosed with an autism spectrum disorder who are under the age of twenty-one and would otherwise meet institutional level of care. The depar…

The department may not pay for: 1. A prescription drug that is within a class of drugs covered under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 [Pub. L. 108-173; 117 Stat. 2066; 42 U.S.C. 1396kk-1] and which is prescribed to a medical assistance re…

The department shall establish a pharmacy management program to be used by the medical assistance program for Medicaid expansion for prescription drug coverage. The department shall process claims through the department's existing pharmacy claims system and Medicaid management in…

1. For purposes of this section: a. "Department" means the department of health and human services or its agent. b. "Health insurer" includes self-insured plans, group health plans as defined in section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167…

1. The department shall seek recovery of reimbursement from a third party up to the full amount of medical assistance paid. 2. A medical assistance recipient shall inform the department of any rights the recipient has to third-party benefits and shall inform the department of the…

1. The department shall establish and implement a buyin program under the federal Family Opportunity Act enacted as part of the Deficit Reduction Act of 2005 [Pub. L. 109-171; 120 Stat. 4; 42 U.S.C. 1396] to provide medical assistance and other health coverage options to families…

1. The medical assistance program must recognize physician assistants and advanced practice registered nurses with the roles of nurse practitioner or certified nurse midwife as primary care providers with the same rights and responsibilities given primary care physicians under th…

1. As part of the personal care services program for eligible medical assistance recipients and as part of the department's services for eligible disabled and elderly individuals, the department shall provide home and community-based services to individuals who have a brain injur…

The department of health and human services shall process claims submitted by enrolled medical providers on behalf of inmates at county jails. Each county shall pay the department for the paid amount for the claims processed and also a processing fee for each claim submission. Th…

The department shall ensure Medicaid coverage includes Medicaid-covered services provided to an inmate of the department of corrections and rehabilitation or a county jail who would be eligible for Medicaid if the inmate were not incarcerated and who is admitted to an inpatient s…

1. For purposes of this section: a. "Affiliate" means a person having an overt or covert relationship each with another person in a manner that one person directly or indirectly controls or has the power to control another. b. "Provider" means any individual or entity furnishing …

1. The department shall expand medical assistance coverage as authorized by the federal Patient Protection and Affordable Care Act [Pub. L. 111-148], as amended by the Health Care and Education Reconciliation Act of 2010 [Pub. L. 111-152] to individuals under sixty-five years of …

1. Medical assistance must cover services provided by community emergency medical services personnel, and other similarly licensed personnel who are licensed or certified under section 23-27-04.3, if the services are provided to an eligible recipient as defined by rule. Community…

Beginning January 1, 2016, the department shall allow licensed marriage and family therapists to enroll and be eligible for payment for behavioral health services provided to recipients of medical assistance, subject to limitations and exclusions the department determines necessa…

1. As used in this section: a. "Care coordination agreement" means an agreement between a health care provider and tribal health care organization which will result in one hundred percent federal funding for eligible medical assistance provided to an American Indian. b. "Tribal h…

The department shall seek the necessary approval from the centers for Medicare and Medicaid services to expand medical assistance coverage for pregnant women with income below one hundred seventy-five percent of the federal poverty level. Services under this section must be for t…

The department shall provide payment to medical assistance providers and may provide payments to provider applicants using an automated clearing house to provide for electronic fund transfers. To receive payment, medical assistance providers and provider applicants shall provide …

Medical assistance coverage must include coverage of a metabolic supplement if: 1. The metabolic supplement has been identified and agreed to be covered by the department; 2. The metabolic supplement is part of a standard recommendation for treatment; 3. A suitable metabolic supp…