Intensive Outpatient Services For Dual Eligible Billable To Medicare Under State Medicaid Plan Rules
State Medicaid programs for dual eligibles can benefit from Medicare’s change in 2024 to cover intensive outpatient program (IOP) services rendered by a hospital, community mental health centers (CMHCs), federally qualified health centers (FQHCs), rural health centers (RHCs), or by an opioid treatment program (OTP). The Medicare coverage started in January 2024, which means that for dual eligible beneficiaries, Medicare has become the primary payer, rather than the state Medicaid program.
An IOP provides treatment at a level more intense than outpatient day treatment or psychosocial rehabilitation, but less intense than a partial hospitalization program (PHP). Medicare previously covered . . .