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Special Bulletin: Review of Durable Medical Equipment Rates

Friday, December 21, 2018

NC Medicaid has been reviewing the Medicaid Durable Medical Equipment (DME) rates to comply with the new Centers for Medicare and Medicaid (CMS) Upper Payment Limit (UPL) requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.

Effective January 1, 2018, CMS enacted new guidelines regarding federal Medicaid reimbursement to states for certain DME prohibiting reimbursement that is, in the aggregate, in excess of what Medicare would have paid for such items.

NC Medicaid will continue engaging with CMS and stakeholders to analyze the current DME rate structure and develop revised rates that will adhere to the new CMS guidelines. It is the intention of the State to comply with the CMS guidelines while still maintaining current levels of access to care and minimizing the fiscal impact to providers that rate changes might cause.

NC Medicaid will work with both the DME provider community and CMS to come to an amicable resolution.