Oversight of Durable Medical Services: Key Considerations for Health Plans

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Health plans increasingly will be required to manage, monitor, and oversee a broader range of services as more states contract for managed long-term services and supports (LTSS).  Oversight includes preventing fraud and abuse, which requires ensuring that the services billed are actually provided.  Oversight also involves ensuring adherence to service plans that support members’ goals for maintaining independence and living in the community.  Providing oversight of durable medical equipment (DME) suppliers may be a new activity for health plans.  This brief highlights considerations for developing DME supplier oversight mechanisms.

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