Medicaid Managed Care

Primary Care Case Management Program (PCCM)

The PCCM program (or Primary Care Provider program) is available as the Managed Care Program within the state. This program functions Statewide. Certain Medicaid populations are required to enroll in the PCCM program. Recipients either choose or are assigned to a Primary Care Provider (PCP). The PCCM program functions to provide adequate access to Primary Care; to provide coordination and continuity of health care services, to avoid duplication of services, to focus on delivering high quality, and to ensure efficient and effective health care services.

Any inquires regarding the programs of Primary Care Case Management (PCCM), ExperienceHealthND (Health Management), or the Program of all Inclusive Care of the Elderly (PACE) can be sent to the following mailbox: dhsmci@nd.gov

Recipient Information

The PCCM program requires all non-emergent health care services be received from your PCP. If you require specialty or hospital services, a referral from your PCP is required prior to the appointment. Some services do not require a referral. It is important to review the PCCM handbook. A listing of services and whether referral requirements are needed is listed within this handbook. If you have questions regarding this program, contact your County Case Worker or the ND Medicaid office.

Primary Care Case Management Handbook

This booklet describes ND Medicaid's Primary Care Case Management Program, copayment requirements, referral process, client responsibilities, and addresses commonly asked questions .

• Primary Care Provider Booklet (428 kb pdf)

Primary Care Provider Information

Information regarding Managed Care can be found in the General Information for Providers Manual in the Managed Care Chapter.

• Primary Care Case Management Referral Guide (26kb pdf)
• Primary Care Case Management Referral Form (225kb pdf)
• Nurse Practitioner PCP Opt-in Letter dated November 30, 2009 ( kb pdf)

Health Management Program

Effective October 1, 2011, ND Medicaid will begin transitioning the current disease management program to a Health Management program. Program services include patient-centered care coordination, telephone contact with a care coordinator or nurse within the clinic, involvement from a team of medical professionals as needed, and patient education. Inquires or comments regarding this Program may be sent to dhsmci@nd.gov, or by contacting a Health Management team within your local area.

• Recipient Correspondence - 9/27/2011 (40kb pdf)
• Provider Correspondence - 10/4/2011 (41kb pdf)

Current ND Medicaid Health Management team:

• ExperienceHealthND (Coverage area - Statewide)
  • Available toll-free at 1-866-435-4306

June 30, 2011 - The renewal for the 1915(b)(4) Managed Care Waiver was submitted to the Centers for Medicare and Medicaid Services (CMS). Listed below are the documents submitted.

• 1915(b)(4) Waiver (239kb pdf)

Program of All-Inclusive Care for the Elderly (PACE)

More detailed information regarding the PACE Program through ND Medicaid & Northland can be accessed by clicking the links below.

• Northland PACE Website
• PACE Fact Sheet (66kb pdf)

Managed Care State Plan

Section 4701 of the Balanced Budget Act of 1997 permits states to require medicaid beneficiaries to enroll with a managed care entity as a state plan option rather than through a 1915 waiver. The state plan was approved by Centers for Medicare and Medicaid Services (CMS) and was effective July 1, 2001. The files contain the state plan material as approved by CMS.

• Page 11 (8kb pdf)
• Managed Care SPA (7.32 MB pdf) approved and effective 12-1-2009

 Top of page    Back to previous page