Obama Budget to Curb DME Medicaid Reimbursement

The Obama Administration’s all-ecompassing 2015 Budget includes provisions that aims to limit Medicaid reimbursement for durable medical equipment (DME) in efforts to reduce federal spending in the coming year and beyond. 

One of the main provisions included in the 2015 Budget details using Medicare bid rates under the DME Competitive Bidding Program for Medicaid reimbursement, as a method to “increase efficiency for DME payments,” according to a budget brief from the Department of Health and Human Services (HHS).

Doing so is expected to save Medicare more than $26.8 billion, and Medicare beneficiaries approximately $17.9 billion over the next 10 years.

“This proposal extends some of these efficiencies to Medicaid by limiting federal reimbursement for a state’s Medicaid spending on certain DME services to what Medicare would have paid in the same state for those services,” the brief notes.

The 2015 Budget also includes language to modify the documentation requirement for face-to-face encounters for DME claims.

Currently, a physician is required to document a beneficiary’s face-to-face encounter with a physician or non-physician practioner as a condition for Medicare payment for an order. 

“This proposal would modify that requirement by allowing certain non-physician practioners to document the face-to-face encounter,” says the HHS budget brief. 

This modification is not expected to have a budget impact. 

Written by Jason Oliva