Medicare payment rules prohibit reimbursement for services when the beneficiary is not financially responsible for the care or when another government agency is required to provide or pay for the goods or services. For many years, Medicare regulations interpreting and enforcing this general prohibition have used a very broad definition of detention that applies to people in the custody of criminal authorities. In addition to people physically detained in jails and prisons, this rule allows for the provision of bail, parole, probation, and home detention in situations where federal and state laws require the facility to provide and pay for necessary medical care. Barriers are being put in place for people inside to pay for treatment. Half-way houses. This meant that people who lived in the community and sought and received care from health care providers unaffiliated with criminal authorities were denied Medicare coverage.
This disconnect was unique to Medicare. Medicaid and health insurance obtained through the ACA Marketplaces are also prohibited from payment if the insured is not responsible for medical costs and/or there is another responsible government agency, but their payment policies , individuals are allowed to assume responsibility upon release. Since the person procures and pays his or her own medical expenses, the prohibition on payments should not apply, even if there is any continuing relationship between the criminal authority and the registrant.
CMS’s latest rule brings Medicare in line with other government health insurance and modern criminal justice practices by eliminating payment limitations for people on bail, parole, probation, home detention, or mandatory halfway house. It is tailored to the reality of the world. houses.
As part of this change, CMS is also updating the definition of custody for purposes of the existing Special Enrollment Period for recently incarcerated people and those released from physical custody and on bail, parole, or probation. is planned to be allowed. or home detention, and individuals who are required to reside in a half-house in order to enroll or reenroll in Medicare Part B, do not have to wait until their status ends to reestablish Medicare coverage. This change increases access to care during a complex transition period and also increases administrative simplicity by more closely aligning with the Social Security Administration’s standards for determining incarceration status.
read Full rules here.
