SPA# MP-23-0006 Effective Date: April 1, 2023
Description: 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 September 30, 2023.
Affected services are described below:
SUSPENDED:
Dental Services
Outpatient Physical Therapy and Related Services
Home Health Physical Therapy, Home Health Aide, or Medical Social Worker services
Prosthetic Devices
Vision Services
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 (EPSDT) services through prior authorization. Prior Authorization requests must accompany physician certification of medical necessity.
LIMITED:
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**
Transportation**
*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 (EPSDT) services through prior authorization. Prior Authorization requests must accompany physician certification of medical necessity.
**Prescribed Drugs will be limited to generics only. Prescribers and pharmacists are required to make good faith efforts in ensuring first-line therapies are available in generic.
**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 Corporation (CHCC), Tinian Health Center (THC), Rota Health Center (RHC), or a Federally Qualified Health Center (FQHC):
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
Exceptions may be made if CHCC or the FQHC is unable to provide the services in a timely manner by a written authorization signed by the designated staff. The Service Provider Exception Authorization Form must be completely filled and signed by the two entities.
EXCLUSIONS:
Dialysis Services will remain available at any of Medicaid’s approved provider networks in the CNMI.
For more information, please contact the Commonwealth Medicaid Agency:
Saipan
Gov’t Bldg 1252, Capitol Hill
Monday – Thursday
Closed on Fridays & Holidays
7:30 am – 1:00 pm
Contact no.
(670) 664-4880/4882
Tinian
Tinian Health Center
Monday – Friday
7:30 am – 4:30 pm
Contact no.
(670) 433-9263/33
Rota
Rota Health Center
Monday – Friday
7:30 am – 4:30 pm
Contact no.
(670) 532-9461/62
Email: info@cnmimedicaid.org
Website: medicaid.cnmi.mp
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