CMS Publishes Cost-Sharing Claim Processing Changes for Dual Eligibles
WASHINGTON, DC – The recently published FY2022 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System final rule (CMS-1752-F) includes a clarification that would help improve access for dual eligible beneficiaries. CMS clarifies that state Medicaid programs are required to cost-share Medicare claims even if the provider and/or supplier is not enrolled with the Medicaid program.
State Medicaid programs will need to be in compliance with this change for claims with dates of service starting January 1, 2023. Language on this can be found in Section X Medicaid Enrollment of Medicare Providers and Suppliers for Purposes of Processing Claims for Cost-Sharing for Services Furnished to Dually Eligible Beneficiaries.
In addition, CMS shared that the Agency is considering requiring State Medicaid programs to process claims for Medicare cost-sharing without requiring claims to meet Medicaid State plan coverage and payment rules. This announcement can be found on page 45502 of the printed Federal Register. This consideration is similar to a recommendation AAHomecare submitted previously regarding dual eligible issues. AAHomecare will be monitoring this potential positive change.
DME MACs Announce Updates to the Upcoming TPE Restart
WASHINGTON, DC – The temporary hold on DME MAC Targeted Probe and Educate (TPE) program due to the COVID-19 Public Health Emergency (PHE) is set to restart soon. DME MACs have been permitted to perform TPE and the 10-claim pre-TPE. All TPE cases that were open early in the pandemic that were put on hold are now officially closed. All suppliers that are selected moving forward will be starting at Round 1.
CMS has not directed DME MACs on when TPEs will be restarting, but AAHomecare anticipates it will start sometime later this month. For additional information and resources, visit CMS’ TPE Program page, Noridian’s announcement, and CGS’s announcement.
CMS Announces Support Measures for Louisiana and Mississippi in the Wake of Hurricane Ida
CMS announced flexibilities to ensure health care access continues for residents in Louisiana and Mississippi impacted by Hurricane Ida. In their release, CMS includes measures related to DME:
Medical Equipment and Supplies Replacements: CMS will temporarily waive certain requirements to enable people with Medicare who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the hurricane to receive replacements of such items and services. This will help to ensure beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance.
CMS has also shared these details on oxygen exchange and charging stations for individuals with medical equipment with us:
Oxygen Exchange Sites — The New Orleans Health Department, the New Orleans Fire Department, and the Louisiana Department of Health are working with residents who are power dependent for medical reasons. As part of this initiative, the City will be opening Oxygen Exchange sites across the city, where residents who are on oxygen can swap out an empty tank for a full tank, free of charge.
The following locations will open at 8 a.m. to 6 p.m.:
• New Orleans Fire Station 1, 2920 Magazine St
• New Orleans Fire Station 36, 5403 Read Blvd
• New Orleans Fire Station 6, 4500 Old Gentilly Rd
• New Orleans Fire Station 40, 2500 General de Gaulle Dr
If you need oxygen and cannot get to any of these sites, call the Special Needs Registry at 504-658-2558. BE EXTREMELY CAREFUL ON THE ROADS AS HAZARDS AND DEBRIS ARE EVERYWHERE.
Charging Stations will be open for residents to power electronic and medical devices:
• Central City Senior Center, 2101 Philip St. 8am – 6pm
Updated information should be available at ready.nola.gov (site is currently experiencing delays) as well as the related @nolaready Twitter feed.
Our thoughts are with the dedicated HME professionals who are serving patients under these challenging and dangerous conditions. Please share any updates on your situation with Gordon Barnes at [email protected].
