Durable Medical Equipment (DME)

Strategies to Support Dually Eligible Individuals’ Access to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

This Centers for Medicare & Medicaid Services (CMS) Informational Bulletin provides an additional strategy for states to support timely access to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for people dually eligible for Medicaid and Medicare. The Informational Bulletin clarifies that states do not need to require a Medicare denial for DMEPOS that Medicare routinely denies as non-covered under the Medicare DME benefit.

Building a Stronger Foundation for Medicare- Medicaid Integration: Opportunities in Modifying State Administrative Processes

This brief describes several administrative changes that state Medicaid programs can make to: (1) support integration efforts; (2) improve beneficiaries’ experience of care; (3) decrease beneficiary out-of-pocket costs; and (4) reduce provider burden. Taking the steps described in this brief may help states build stronger, more effective integrated care programs and better position them to implement larger-scale integration efforts for their dually eligible populations.

Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches

This brief describes how three states – California, Connecticut, and Illinois -- promote dually eligible beneficiaries’ access to durable medical equipment (DME) in a fee-for-service environment through the use of provisional prior authorization policies and online lists of DME that Medicare generally does not cover.

Improving Coordination of Home Health Services and Durable Medical Equipment for Medicare-Medicaid Enrollees in the Financial Alignment Initiative

September-14

This presentation highlights issues with overlapping coverage for home health services and durable medical equipment (DME), and describes the Health Plan of San Mateo's approach to coordinating these services, including operating protocols, denials of coverage, grievances and appeals, and encounter data and performance reporting.

Improving Coordination of Home Health Services and Durable Medical Equipment for Medicare-Medicaid Enrollees in the Financial Alignment Initiative

This brief outlines challenges caused by the overlap in Medicare and Medicaid coverage for home health services and durable medical equipment and describes options for addressing these issues in the Financial Alignment Initiative and other integrated care initiatives.