New Proposed Rule to Improve State Processing of Cost Claims for Dually Eligible Populations

To help our members who assist people eligible for both Medicare and Medicaid stay abreast of important policy developments, we share the announcement below by the Centers for Medicare and Medicaid Services. The proposal is still in the early stages and is not a final rule – advocates have until June 28 to comment on the proposal.

“Announcing CMS FY2022 IPPS/LTCH PPS proposed rule (CMS-1752-P); Medicaid Provider Enrollment and Medicare Cost-sharing for Dually Eligible Beneficiaries

On April 27, 2021, CMS issued the FY2022 IPPS/LTCH PPS proposed rule (CMS-1752-P). CMS is writing you today to flag one proposal that aims to improve state processing of Medicare cost sharing claims for services provided to dually eligible individuals. Specifically, this proposal would require state Medicaid agencies to allow enrollment of all Medicare-enrolled providers and suppliers for purposes of processing claims for Medicare cost sharing on services for dually eligible individuals. If finalized, this proposal will improve compliance with current statute and reduce burden for providers related to crossover claims submission and the claiming of Medicare bad debt.

Additionally, we are requesting information from stakeholders on instances where states determine their cost-sharing liability for a Medicare service by applying the Medicaid payment and coverage rules for the service as if the service (rather than the cost-sharing) were being paid by Medicaid.

The NPRM is available at https://www.federalregister.gov/public-inspection/2021-08888/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the. For the provision specific to dually eligible individuals, please see Section X (“Medicaid Enrollment of Medicare Providers and Suppliers for Purposes of Processing Claims for Cost-Sharing for Services Furnished to Dually Eligible Beneficiaries”) and proposed changes to regulatory text in 42 CFR 455.10. As always, we encourage you to review closely and comment. The comment period closes on June 28, 2021.”