Patient Eligibility and Coverage Guidelines

A condition of NDMS coverage is the patient must be transported via Federal assets, processed through a Federal Coordinating Center (FCC), and referred to facilities or practitioners for definitive medical care. The NDMS tracks all NDMS federal patients who are transported via Federal assets and thus, are eligible for coverage under this program.

Authorized emergency response and disaster relief personnel responding to the public health emergency who suffer injuries or illnesses are also eligible for NDMS Definitive Care Program coverage.

Generally, any medically necessary service which is authorized under Medicare Part A, Medicare Part B or a State’s Medicaid program is eligible for reimbursement as long as the NDMS federal patient sustained one of the following:

• injuries or illnesses resulting directly from a specified public health emergency; or
• injuries, illnesses, and conditions requiring essential medical services necessary to maintain a reasonable level of health temporarily not available as a result of the public health emergency; or
• injuries or illnesses affecting authorized emergency response and disaster relief personnel responding to the public health emergency.

The NDMS Definitive Care Reimbursement Program coverage ends when one or more of the following conditions is met:

• the patient’s medically indicated treatment ends (maximum reimbursable duration of 30 days, unless otherwise directed);
• the patient voluntarily refuses care;
• thirty calendar days have elapsed from the date of the patient’s evacuation/placement (unless otherwise directed); or
• the patient is returned home or to the point of origin (or a fiscally comparable location) or to the patient’s destination of choice.

The NDMS Reimbursement Program will pay primary under the following circumstances:

• the patient is uninsured;
• the patient is covered only by Medicaid; or
• the patient is only covered by another payer of last resort.

Note: The NDMS Definitive Care Reimbursement Program does not supersede contracts that providers have with other payers which require the payer’s reimbursement be accepted as payment in full (also referred to as “Assignment”). In these cases where the provider has agreed to accept Assignment from another payer, the NDMS Definitive Care Reimbursement Program will not make any secondary payments.

The NDMS Definitive Care Reimbursement Program will make no primary or secondary payments for patients with:

• TRICARE coverage.
• Medicare coverage.
• Free care-eligible veterans treated in Veterans Affairs hospitals