Public Health Emergency - Leading a Nation Prepared
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.
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.
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.
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:
The NDMS Definitive Care Reimbursement Program coverage ends when one of the following conditions is met:
The NDMS Reimbursement Program will pay primary under the following circumstances:
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:
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