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GUIDANCE Sliding Coinsurance for CMS/Medicare Care Management Services

Resource Topic: Clinical Issues

Resource Subtopic: Diabetes, —Quality Improvement, —Value-Based Health Care Transformation.

Keywords: Fees and Charges, Insurance and Claims.

Year Developed: 2020

Resource Type: Publication

Primary Audience: C-Suite (CEOs, CFOs, CIOs, COOs, CMOs, etc.); Clinicians,PCAs

Language: English

Developed by: National Association of Community Health Centers (See other resources developed by this organization).

Resource Summary: While health centers are required to impose Medicare coinsurance for CMS/Medicare care management services, the coinsurance may be “slid” commensurate with the sliding fee discount program (SFDP) policy of the health center. Federal anti-kickback statutes and beneficiary inducement prohibitions include exceptions allowing health centers to discount coinsurance for patients who are eligible for the health center’s sliding fee discount program without violating Medicare rules.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,375,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.