North Dakota legislators propose $500 rate for psychiatric leave days reimbursement

The North Dakota House Appropriations Committee convened on April 8, 2025, to discuss significant changes to Medicaid reimbursement rates for psychiatric residential treatment facilities (PRTFs). The meeting focused on whether to approve a bill that would allow for payment of full Medicaid rates even when residents are temporarily absent from the facility.

Sarah Acre, Executive Director of the Division of Medical Services, presented data comparing North Dakota's PRTF rates with those of neighboring states, highlighting disparities in reimbursement rates for similar services. The committee expressed concerns about the implications of paying full rates for therapeutic leave days when residents are not present, with some members questioning the fairness of the current rate-setting methodology.

A key point of contention was the significant variation in rates between facilities, which can lead to higher costs for facilities with lower occupancy rates. Acre explained that the rates are determined based on each provider's costs and occupancy levels from the previous year. This has led to frustrations among committee members, particularly regarding how these rates do not reflect the actual service delivery and occupancy.

The committee debated potential solutions, including a flat reimbursement rate for therapeutic leave days. Representative Murphy suggested a tiered rate based on occupancy levels, while others proposed a flat rate of $500 per day for leave days. Ultimately, the committee voted to support a motion that would set the reimbursement at $500 per day, with the Department of Health and Human Services authorized to manage the number of leave days per individual.

The decision aims to balance the need for facilities to maintain financial viability while encouraging family engagement in care. The committee acknowledged that this is a temporary measure, pending further evaluation of the reimbursement structure in future budget cycles. The bill will now proceed to the full committee for further consideration.