As previously reported, the 21st Century Cures Act prohibits federal financial participation (FFP) payments to the states for certain Medicaid durable medical equipment (DME) expenditures that exceed what Medicare would have paid for such items, either on a fee schedule basis or under competitive bidding. The provision is effective January 1, 2018.
CMS recently provided guidance to the states on the scope of the FFP limitation, noting that it only applies to DME covered by a state’s Medicaid program on a fee-for-service (FFS) basis that is also covered by Medicare. The FFP limitation does not apply to prosthetics, orthotics, or medical supplies, nor does it apply to items for which Medicaid is not the primary payer.
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