Effect of Other
Insurers/Payers
If a beneficiary is eligible for both Original Medicare and Medicaid (dually
eligible) or is covered by Original Medicare and another insurance program or
payer (such as waiver programs, Office on Aging funds, community agencies
(e.g., Easter Seals) or grants), ABN requirements still apply. For
example, when a beneficiary is a dual eligible and receives home health
services that are covered only under Medicaid, but are not covered by Medicare
for one of the reasons listed in Table 1; an ABN must be issued at the initiation of this care to inform the beneficiary that
Medicare will likely deny the services.
Some States have specific rules regarding HHA completion of liability notices
in situations where dual eligible beneficiaries need to accept liability for
Medicare noncovered care that Medicaid will cover. Medicaid has the
authority to make this assertion under Title XIX of the Act, where Medicaid is
recognized as the “payer of last resort” (meaning other Federal programs like
Medicare (Title XVIII) must pay in accordance with their own policies before
Medicaid assumes any remaining charges)
On the ABN, the first check box under the “Options” section indicates the
choice to bill Medicare and is equivalent to the third checkbox on the outgoing
HHABN. HHAs serving dual eligibles should comply with existing HHABN State
policy within their jurisdiction as applicable to the ABN unless the State
instructs otherwise.