Contract suppliers must be enrolled in Medicaid

Thursday, August 22, 2013

WASHINGTON – Contract suppliers in competitive bidding areas can’t bill dual-eligible beneficiaries for co-pays if they’re not enrolled in the Medicaid program in the relevant state, AAHomecare has notified members in a bulletin. This extends to Medicaid managed care organizations. The association had sought clarification from CMS on the issue. Additionally, the prohibitions against billing dual-eligible beneficiaries for Medicare cost-sharing (i.e. deductible and co-insurance) apply under the program. The Medicaid statute considers payments from Medicare and Medicaid as payments-in-full for items provided to dual-eligible beneficiaries, according to AAHomecare. Beneficiaries are under no legal obligation to make further payment to providers. Providers who charge dual-eligible beneficiaries for cost-sharing could face penalties, the association says. States must pay providers for any Medicare cost-sharing for dual-eligible beneficiaries. To be paid, providers must be enrolled with Medicaid in each state in their service area.