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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyNorth Dakota PRTF Rate Policy Update | OpenPayer
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    ModifiedNorth Dakota Department of Health & Human ServicesPolicy 23-0038

    PRTF Per Diem Reimbursement Rates

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    This policy governs North Dakota Medicaid daily per diem rates for in-state and out-of-state psychiatric residential treatment facilities, including rate determinations, reconsideration, appeals, and out-of-state payment methodology.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyPRTF Per Diem Reimbursement Rates
    Policy CodePolicy 23-0038
    Change TypeModified
    Effective DateJan 1, 2024
    Next Review DateNot specified
    Key ActionRequest reconsideration of a final rate within 30 days of written notification.
    SourceLink
    POLICY UPDATE CHANGES

    The daily-rate calculation provision is revised to apply to dates of service beginning January 1, 2024.

    1/4three%Inflation factor
    30 daysReconsideration deadline
    30 daysAppeal deadline
    Lower of two ratesDefault out-of-state payment

    Out-of-State PRTF Payment Methodology

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyPRTF Per Diem Reimbursement Rates
    Policy CodePolicy 23-0038
    Change TypeModified
    Effective DateJan 1, 2024
    Next Review DateNot specified
    Key ActionRequest reconsideration of a final rate within 30 days of written notification.
    SourceLink
    On This Page
    Out-of-State PRTF Payment MethodologyReconsideration and Appeal DeadlinesRate Review and Appeal Actions

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Out-of-state PRTF payment methodology

    Out-of-state PRTF payment is determined according to the following sequence.

    1. Comparable rate established: If the Medicaid agency in the state where the out-of-state PRTF is located has established a rate for comparable services, pay the rate established by that state's Medicaid agency for comparable services.
    2. No comparable rate established: If the Medicaid agency in the state where the out-of-state PRTF is located has not established a rate, pay the lower of the PRTF's billed charges or the average per diem rate in effect for in-state PRTFs when services are first provided by the out-of-state PRTF.
    3. Extraordinary or unusual circumstances: For extraordinary or unusual circumstances, the state may negotiate a per diem rate above the average in-state per diem rate on a case-by-case basis. The negotiated per diem rate may not exceed the PRTF's cost of providing the service.

    Reconsideration and Appeal Deadlines

    Reconsideration Request Deadline
    Request reconsiderationWithin 30 days of written notification of a final rate
    Appeal Deadline
    File an appealWithin 30 days of written notice of the Department's reconsideration decision

    Rate Review and Appeal Actions

    Note

    Request Reconsideration of Final Rate

    A PRTF dissatisfied with the results of a final rate determination may request reconsideration of the final rate within 30 days of the written notification of the final rate.

    Note

    Appeal the Reconsideration Decision

    A PRTF dissatisfied with the Department’s decision regarding a reconsideration determination may file an appeal within 30 days of the written notice of the Department’s decision.