CMS issues guidance for dual-eligibles

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Thursday, January 19, 2017

WASHINGTON – CMS has published guidance to help states ensure access to DMEPOS is available for dual-eligible beneficiaries. Those strategies are: recommend prior approval; ensure DME claims for dual-eligibles are assessed against Medicaid’s broader coverage criteria; and ensure Medicaid is only looking for Medicare prior authorizations on those items and in those states that Medicare requires it. The guidance also states that states should consider incorporating these requirements and strategies into contracts with Medicaid MCOs.