US · guidance
CMS Pub. 100-04, ch. 36, § 50.11
Claims Submitted for Medicare Beneficiaries Previously Enrolled in a
Medicare Advantage Plan
(Rev. 2231, Issued: 05-27-11, Effective: 08-28-11, Implementation: 08-28-11)
Under DMEPOS Competitive Bidding, if a beneficiary resides in a CBA and elects to leave their
MA plan or loses his/her coverage under this plan, the beneficiary may continue to receive items
requiring frequent and substantial servicing, capped rental, oxygen and oxygen equipment, or
inexpensive or routinely purchased rented items from the same DME supplier under the MA plan
without going to a contract supplier under the Medicare DMEPOS Competitive Bidding
Program. However, the supplier from whom the beneficiary previously received the item under
the plan must be a Medicare enrolled supplier; meet the Medicare FFS coverage criteria and
documentation requirements; and must elect to become a grandfathered supplier. All
competitive bid grandfathering rules apply in these situations.
History
(Rev. 2231, Issued: 05-27-11, Effective: 08-28-11, Implementation: 08-28-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1d8b4be5c639513d91907a8320670c5573ab4b3ae666615142db7c801add5948
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