Coordinated Services Program 510-03-95-45
(New 6/1/2015 ML #3441)
North Dakota Medicaid's Coordinated Services Program (CSP) (formerly Lock-In program) helps individuals find healthcare services that match their medical needs. Individuals have one coordinated services medical provider and one pharmacy provider who will work regularly with them to understand their health care needs and coordinate your care. The coordinated services medical provider can also refer them to specialists who can help maintain and improve their health.
This program was developed to assist individuals eligible for Traditional Medicaid coverage who may be unintentionally misusing program benefits and to ensure the continuity and quality of care for recipients. When deciding if someone meets the criteria to be placed on the CSP, the following areas are examples of what is taken into consideration;
- Use of multiple providers and clinics;
- Early prescription refills;
- Use of multiple pharmacies;
- Trips to the emergency room (ER) for services other than emergent care. Examples of non-emergent care include, refills of medication, chronic pain, headaches including migraines, constipation, or menstrual cramps;
- Use of multiple controlled drugs; and
- Prescriptions obtained from multiple providers
The State is to inform the insurance vendor of individuals who were participating in the CSP Program while eligible for Traditional Medicaid coverage, when their coverage changes to Medicaid Expansion coverage. The Insurance vendor is required to apply a similar policy under the insurance coverage provided.
