For purposes of rental and purchase of DME, a beneficiary's home may be the beneficiary's
own dwelling, an apartment, a relative's home, a home for the aged, or some other
type of institution may not be considered a beneficiary's home if it:
Meets at least the basic requirement in the definition of a hospital; i.e., it is
primarily engaged in providing by or under the supervision of physicians, to inpatients,
diagnostic and therapeutic services for medical diagnosis, treatment, and care of
injured, disabled, and sick persons, or rehabilitation services for the rehabilitation
of injured, disabled, or sick persons or
Meets at least the basic requirement in the definition of a skilled nursing facility;
i.e., it is primarily engaged in providing to inpatients skilled nursing care and
related services for patients who require medical or nursing care, or rehabilitation
services for the rehabilitation of injured, disabled, or sick persons.
Thus, if an individual is a patient in an institution or distinct part of an institution
which provides the services described in 1. or 2. above, the individual is not entitled
to have payment made for rental or purchase of DME since such an institution may not
be considered the individual's home.
Payment may also be made for repairs, maintenance, and delivery of equipment as well
as for expendable and nonreusable items essential to the effective use of the equipment
subject to the conditions in HI 00610.220.
When covered DME is furnished to a beneficiary by a supplier of services other than
a provider of services, reimbursement is made by the carrier on the basis of the reasonable
charge. If the equipment is furnished by a provider of services, reimbursement is
made to the provider by the intermediary on the basis of whichever is lower; the provider's
customary charge or the reasonable cost of the covered services.