From 2004 to 2024, the Health Resources and Services Administration (HRSA) funded the National Coordinating Center for the Regional Genetics Networks (NCC). NCC developed and maintained the Genetics Policy Hub.

With the conclusion of NCC funding, the Genetics Policy Hub (GPH) will no longer be updated or maintained. Information on GPH should be used for historical reference only.

North Dakota

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Updated on October 12, 2023

This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.

Medicaid Coverage Information Published

Yes

State Contact Information

Krista Fremming
Interim Director of Medical Services Division
North Dakota Department of Human Services
600 E. Boulevard Avenue, Dept. 325 Bismarck, ND 58505-0250
Phone: (701) 328-1603

https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf

General Genetic Testing Criteria

Genetic Testing Not Covered

Pharmacogenetic panel tests for therapy selection, such as panel tests for psychotropic, analgesics, or ADHD stimulant medications is NOT covered.

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

An applicant for a genetic counselor licensure shall pay any filing fee and file anapplication, on forms provided by the board, to the satisfaction of the board that the applicant is of good moral character and satisfies all of the requirements of this chapter, including:

Education at one of the following levels:
1. Master of science degree from a genetic counseling training program that is accredited by the ABGC or an ABGC-approved equivalent organization and approved by the board; or
2. Doctoral degree from a medical genetics training program that is accredited by the ABMG and approved by the board; and
Successful completion of all requirements of the certification examination within a period not to exceed four years from initial examination to successful completion and with no more than three attempts;
Physical, mental, and professional capability for the practice of genetic counseling in a manner acceptable to the board; and
A history free of any finding by the board, by any other state licensing board, or by any court of competent jurisdiction which would constitute grounds for disciplinary action under this chapter. The board may modify this restriction for cause.

Metabolic Formula Coverage Legislation

NDCC §26.1‐36‐ 09.7

Metabolic Formula Coverage & Criteria

26.1-36-09.7. Foods and food products for inherited metabolic diseases.
As used in this section:

“Inherited metabolic disease” means maple syrup urine disease or phenylketonuria.
“Low-protein modified food product” means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a natural food that is naturally low in protein.
“Medical food” means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered under the direction of a physician.
An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy, health service contract, or evidence of coverage that provides prescription coverage on an individual, group, blanket, franchise, or association basis, unless the policy or contract provides, for any person covered under the policy or contract, coverage for medical foods and low-protein modified food products determined by a physician to be medically necessary for the therapeutic treatment of an inherited metabolic disease.
This section applies to any covered individual born after December 31, 1962. This section does not require coverage in excess of three thousand dollars per year total for low-protein modified food products or medical food for an individual with an inheritedmetabolic disease of amino acid or organic acid.
This section does not require medical benefits coverage for low-protein modified food products or medical food for an individual to the extent those benefits are available to that individual under a department of health and human services program.

Prior Authorization Requirements

Prior Authorization Forms

https://www.nd.gov/eforms/Doc/sfn00527.pdf