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Grandfathering Information

If a beneficiary who resides in a competitive bidding area (CBA) changes from a Medicare Advantage (MA) Plan, either voluntarily or involuntarily, to Medicare fee-for-service (original Medicare), can he/she remain with his/her current managed care supplier even if the supplier is not a contract supplier for the specific competitively bid item the beneficiary receives from the supplier? Will Medicare continue to pay the supplier for the items and services?

Are competitively bid capped rental items subject to the payment reduction after the 3rd month rental?

Can a non-contract supplier furnish competitively bid items to beneficiaries maintaining a permanent residence within a CBA?Open in New Window

Can a supplier choose to grandfather certain beneficiaries and not others?

If a beneficiary has been renting a competitively bid durable medical equipment (DME) item from a supplier that does not become a contract supplier and chooses to switch to a contract supplier at the start of a competitive bidding program, what month should the new contract supplier start billing? When can the non-contract supplier pick up its equipment?

If a beneficiary who is receiving capped rental durable medical equipment (DME) or oxygen prior to the start of the competitive bidding program moves from a non-competitive bidding area to a competitive bidding area (CBA), is a contract supplier eligible to start a new capped rental period or entitled to receive additional payments for oxygen?

What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?


last updated on 07/30/2014


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