Public Notice – CNMI Medicaid State Plan Amendment (SPA) MP-23-0006 Impacts of Services Due to Financial Constraints

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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Office of CNMI Governor and Lt. Governor
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