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.