Qualified Medicare Beneficiary (QMB) Program, CR 39434

January 31, 2014

This change applies to those eligible for QMB without other Medicaid coverage (QMB only). Effective January 1, 2014, the Department limited cost sharing payments to hospital and nursing facility providers in the amount necessary to provide a total payment equal to the amount MaineCare would pay for these services under the State Plan. At this time, these claims will Pend for Edit 6046 -Hosp NH QMB. We will notify you when the edit to pend claims is lifted. No provider action is needed.

Reminder: Providers are strictly prohibited, under 42 USC 1396a(n)(3), from seeking to collect any amount from a QMB for Medicare deductibles or coinsurance, even if the MaineCare payment is less than the total amount of the Medicare deductible and coinsurance. Providers are, however, allowed to collect from the QMB Member any MaineCare copayment for the service.