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CMS Clarifies Guidance on Dual Eligibles 

AAHomecare Summarizes Changes


AAHomecare just announced a summary of positive changes from CMS as a result of Friday’s release of guidance to help streamline claims for dual-eligible patients as well as news of a new initiative that could reduce TPE audit burdens.

CMS 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 that the Medicare program routinely denies as non-covered under the DMEPOS benefit, such as incontinence supplies.

The new guidance also suggests that states consider creating a list of DMEPOS items that are not covered by Medicare to expedite Medicaid coverage and payment for dually eligible individuals.  By doing so, states can avoid requiring suppliers to obtain a Medicare denial while still fulfilling their statutory requirement remaining the “payer of last resort.”  CMS also suggests that states that develop a list of non-Medicare-covered items should also “encourage their Medicaid managed care organizations to adopt the same list of DMEPOS non-covered items for dually eligible individuals.”

AAHomecare has been regularly engaging CMS’ dual-eligibles office over the last 18 months to help streamline the process for determining coverage for this patient population.  The new guidance has the potential to make it easier for suppliers to have claims processed for these services.

AAHomecare will work with state and regional association leaders to encourage state Medicaid authorities to adopt this approach.

See CMS’ new guidance here

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