The Centers for Medicare and Medicaid Services (CMS) prohibit billing Medicaid beneficiaries for broken, missed or cancelled appointments. Medicaid programs are State designed and administered with Federal policy established by CMS. Federal requirements mandate that providers who participate in the Medicaid program must accept the payment of the agency as payment in full. Providers cannot bill for scheduling appointments or holding appointment blocks. According to the CMS Program Issuance transmittal Notice MCD-43-94, broken or missed appointments are considered part of the overall cost of doing business.

If a provider has a non-compliant Medicaid patient, particularly with BROKEN, MISSED OR CANCELLED APPOINTMENTS, they can contact the Family Support Services worker at their local health department. For more information about FSS, go to page 200-6 of the manual.