Review of Maine Bureau of Medical Services' Medicaid Reimbursement for Durable Medical Equipment for Recipients Residing in Nursing Facilities

EXECUTIVE SUMMARY:

This report presents the results of our review of the Maine Bureau of Medical Services' (State Agency's) Medicaid reimbursement for durable medical equipment (DME) purchases and rentals associated with recipients who were also residing in nursing facilities (NFs). The objective of this review was to determine the adequacy of the State Agency procedures and controls over Medicaid payments made to outside providers for DME when recipients were also receiving skilled nursing care during their stays in a nursing facility. Our review disclosed that the State Agency has established policies that do not allow for Medicaid reimbursement of many DME services to outside providers while a recipient is a resident in a nursing facility. Based on results of a computer match and related payment testing, we found that, with few exceptions, the State Agency was adhering to its reimbursement policies and that DME was not being inappropriately charged to the Medicaid program. As a result, we have no further recommendations to make on this issue.

---