Some Medicaid services to be suspended by June 1

The budgetary constraints currently facing the CNMI Medicaid Agency will soon result in some services being suspended or limited on effective June 1, 2023, including dental and vision services.

The Commonwealth Medicaid Agency sent out a notice yesterday regarding amendments to the CNMI Medicaid State Plan that took effect last April 1, but will become effective starting this June.

According to the notice, under the amended plan, Medicaid will temporarily limit, reduce, or suspend some of its services. Fortunately, Medicaid will implement these amendments starting June 1, to ensure that medically necessary services are not disrupted.

“Under the waiver authority of Section 1902(j) of the Social Security Act, the Commonwealth Medicaid Agency will limit, reduce, or suspend services due to financial constraints and cost-cutting measures are critical. In an effort to sustain the program and ensure medically necessary services are not disrupted, temporary limitations, restrictions, or suspensions will be implemented and taken into effect on June 1, 2023, and end no later than Sept. 30, 2023,” said the notice.

The suspended services are:

• Dental services

• Outpatient physical therapy and related services

• Home health physical therapy, home health aide, or medical social worker services

• Prosthetic devices

• Vision services

The notice states that children ages 0-20 years may be excluded from the limitations, reductions, or suspensions of services for the purposes of Early and Periodic Screening, Diagnostic, and Treatment services through prior authorization.

Prior Authorization requests must accompany physician certification of medical necessity.

Limited services include:

• Home health services (skilled nursing services only)

• Durable medical equipment will be restricted to monthly rental only

• Accessories required for the use of a DME and medical supplies will be restricted to critical cases

• Prescribed drugs (prescribed drugs will be limited to generics only).

• Transportation (Air transportation will be reimbursed for medically necessary and emergency purposes and shall be enforced by the Health Network Program. Ground non-emergency transportation must accompany a Physician’s Certification Statement of necessity.)

Restricted to: The Commonwealth Healthcare Corp., Tinian Health Center, Rota Health Center, or a Federally Qualified Health Center.

Other limited services are:

• Outpatient hospital services

• Laboratory and x-ray services

• Family planning and pregnancy-related services

• Physician, licensed practitioner, and any other medical care services

• Clinic services

Dialysis services will remain available at any of Medicaid’s approved provider networks in the CNMI.

For more information, contact the Commonwealth Medicaid Agency. (Kimberly B. Esmores)