by Jared Staheli
June 18th, 2015
The Social Security Act (§1861(n)) specifies that a hospital or a skilled nursing facility (SNF) cannot be considered a patient’s “home” for purposes of the DME benefit. (This restriction of coverage to only those items that are furnished for use in the patient’s home does not apply to coverage under the separate Part B benefits for Prosthetics, Orthotics, and Supplies, which are payable without regard to the particular setting in which they are furnished.)
When DME is furnished for use in a SNF during a covered Part A stay, the DME Regional Carriers (DMERCs) shall not make separate payment for DME, since the DME is already included in the payment that the SNF receives for the covered stay itself. When DME is furnished for use in a SNF during a noncovered stay (SNF benefits exhausted, no qualifying 3-day hospital stay, etc.), the DMERCs still shall not make separate payment for DME, as explained above, Part B’s DME benefit does not cover DME items that are furnished for use in SNFs. Even if a patient already rents or owns a piece of DME in their home, the SNF cannot require the patient to bring their own rented or purchased DME with them into the SNF.