CMS clarifies guidance on dual-eligibles

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Tuesday, January 8, 2019

WASHINGTON – CMS has released updated guidance for state Medicaid programs on Medicare coverage for dual-eligible beneficiaries, clarifying that states do not need to require a Medicare denial for DMEPOS like incontinence supplies that the program routinely denies as non-covered, AAHomecare reports. The guidance also suggests that states consider creating a list of DMEPOS that are not covered by Medicare to expedite Medicaid coverage and payment for dual-eligibles. By doing so, states can avoid requiring providers to obtain a Medicare denial while still fulfilling their statutory requirement remaining the “payer of last resort.” Additionally, CMS suggests that states that develop such a list should also encourage their Medicaid managed care organizations to adopt the same list. “AAHomecare has been regularly engaging CMS over the last 18 months to help streamline the process for determining coverage for this patient population,” the association stated in a bulletin. “The new guidance has the potential to make it easier for suppliers to have claims processed for these services.”