Duplicative Payments Under Parts B or D

40.1.2 - Duplicative Payments Under Parts B or D (Rev. 11219; Issued: 01-27-22; Effective: 01-01-22; Implementation: 03-01-22) Section 1834(w)(1) of the Act, added by section 2005(c) of the SUPPORT Act, requires the Secretary to ensure, as determined appropriate by the Secretary, that no duplicative payments are made under Part B or Part D for items and services furnished by an OTP. Many of the individual items or services provided by OTPs that would be included in the bundled payment rates may also be appropriately available to beneficiaries outside of the OTP benefit. Although CMS recognizes the potential for significant program integrity concerns when similar items or services are payable under separate Medicare benefits, CMS believes it is important that any efforts to prevent duplicative payments not inadvertently restrict Medicate beneficiaries’ access to other Medicare benefits even for the time period they are being treated by an OTP. For example, a beneficiary receiving counseling or therapy as part of an OTP bundle of services may also be receiving medically reasonable and necessary counseling or therapy as part of a physician’s service during the same time period. Similarly, there could be circumstances where Medicare beneficiaries with OUD could receive treatment and/or medication from non-OTP entities that would not result in duplicative payments, presuming that both the OTP and the other entity appropriately furnished separate medically- necessary services or items. Consequently, CMS does not believe that provision of the same kinds of services by both an OTP and a separate provider or supplier would itself constitute a duplicative payment. However, payment for medications delivered, administered or dispensed to a beneficiary as part of the bundled payment or an adjustment to the bundled payment is considered a duplicative payment if a claim for delivery, administration or dispensing of the same medication for the same beneficiary on the same date of service was also separately paid under Medicare Parts B or D. If this occurs, CMS will recoup the duplicative payment made to the OTP.