The NDMS Definitive Care Reimbursement Program will, subject to the availability of funds, reimburse institutions and practitioners that provide Definitive Medical Care to NDMS patients as governed by the following guidelines.
Eligible Patients:
A condition of NDMS coverage is that the patient is transported via Federal assets, processed through a FCC, and referred to facilities or practitioners for Definitive Medical Care. The NDMS tracks all patients who are transported via Federal assets and thus, are eligible for coverage under this program.
Authorized emergency response and disaster relief personnel responding to the public health emergency who suffer injuries or illnesses are also eligible for NDMS Definitive Care coverage.
Eligible Providers:
Only providers who currently participate in either Medicare or Medicaid are eligible for reimbursement. All providers who participate in Medicare will be reimbursed based upon their Medicare rates. Any provider who does not participate in Medicare but does actively participate in Medicaid will be reimbursed based upon their Medicaid rates.
Covered Services:
Generally, any medically necessary service which is authorized under Medicare Part A, Medicare Part B or a State’s Medicaid program is eligible for reimbursement as long as the NDMS patient sustained one of the following:
- Injuries or illnesses resulting directly from a specified public health emergency; or
- Injuries, illnesses and conditions requiring essential medical services necessary to maintain a reasonable level of health temporarily not available as a result of the public health emergency; or
- Injuries or illnesses affecting authorized emergency response and disaster relief personnel responding to the public health emergency.
Coverage Period:
The NDMS Definitive Care Reimbursement Program coverage ends when one of the following conditions is met:
- The patient’s medically indicated treatment ends (maximum reimbursable duration of 30 days).
- The patient voluntarily refuses care.
- Thirty calendar days have elapsed from the date of the patient’s evacuation/placement.
- The patient is returned home or to the point of origin (or a fiscally comparable location) or to the patient’s destination of choice.
Coordination of Benefit Guidelines:
The NDMS Reimbursement Program will pay primary under the following circumstances:
- The patient is uninsured.
- The patient is covered only by Medicaid.
- The patient is only covered by other state or local payer of last resort.
For individuals with private coverage (e.g., employment-based coverage), the NDMS Definitive Care Reimbursement Program may make a secondary payment to cover the difference between the full NDMS payment amount and the other payer’s allowance(s). However, NDMS does not cover co-pays, deductibles or coinsurance associated with the patient’s other coverage other coverage(s)— this includes any Medicare or Medicaid co-pays, deductibles or coinsurance.
Note: the NDMS Definitive Care Reimbursement Program does not supersede contracts that providers have with other payers which require the payer’s reimbursement be accepted as payment in full (also referred to as “Assignment”). In these cases where the provider has agreed to accept Assignment from another payer, the NDMS Definitive Care Reimbursement Program will not make any secondary payments.
The NDMS Definitive Care Reimbursement Program will make no primary or secondary payments for patients with:
- TRICARE coverage.
- Medicare coverage.
- Free care-eligible veterans treated in Veterans Affairs hospitals
