Durable Medical Equipment (DME)

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.

States’ Medicaid Fee-for-Service Durable Medical Equipment Payment Policies

To better inform analysis of existing policies and development of future policies that affect Medicaid payments, the Medicaid and CHIP Payment and Access Commission (MACPAC) released a compendium of each state’s fee-forservice DME policies along with a companion issue brief summarizing payment and coverage policies and issues.

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.

Integrated Care Updates - August 2019

August 2019 Contents:

  • New ICRC Brief on Implementation of D-SNP Information Sharing Requirements
  • CMS Releases New Proposed Rule on Durable Medical Equipment
  • CMS Report on State Balancing of Medicaid Long-Term Services and Supports
  • MACPAC Releases Compendium of State Fee-for-Service DME Polices
  • August 2019 Enrollment in Medicare-Medicaid Plans
  • August 2019 Enrollment in PACE Organizations
  • New Resources on the ICRC Website
  • Key Upcoming Dates

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

Study Hall Call

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.


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