North Dakota Medicaid Waivers

“Waivers are agreements between the Centers for Medicare and Medicaid Services (CMS) and a state’s Medicaid agency and serve specific groups of people.
Waivers specify:
• Number of participants to be served
• Eligibility criteria
• Available services, including any limits on services
• Procedures for the evaluation and re-evaluation of level of care
Waivers give eligible people options if their needs can be met in their homes, and if providing services in a home and community setting is cost neutral compared to institutional services.”

North Dakota Statewide Transition Plan

“Final approval is granted due to the state completing the following activities:

• Conducted a comprehensive site-specific assessment and validation of all settings serving individuals receiving Medicaid-funded HCBS, and included in the STP the outcomes of these activities and proposed remediation strategies to rectify any issues uncovered through the site specific assessment and validation processes by the end of the transition period.
• Outlined a detailed plan for identifying settings that are presumed to have institutional characteristics, including qualities that isolate HCBS beneficiaries, as well as the proposed process for evaluating these settings and preparing for submission to CMS for review under heightened scrutiny;
• Developed a process for communicating with beneficiaries who are currently receiving services in settings that the state has determined cannot or will not come into compliance with the home and community-based settings criteria by March 17 ,2022; and
• Established ongoing monitoring and quality assurance processes that will ensure all settings providing HCBS continue to remain fully compliant with the rule in the future.”

North Dakota Overall Service Plan Instructions

“The OSP consists of two (2) sections:
1. State Individual Service Plan (ISP)which is the pre-authorization of payment for DD Medicaid Waiver and State Plan Services. The ISP is completed by the DD Program Manager, a representative of the State Medicaid agency. This section can only be edited and entered by the DDPM. The ISP lists Title XIX Medicaid funded services that will be provided to the person including the amount, type, frequency, service provider, funding source, and start/end dates. It also lists the generic non-Medicaid funded services the person is receiving. The ISP is the document that authorizes Medicaid payment for DD Title XIX services in the Medicaid payment system. An ISP must be completed in order for payment to be made.”