How Does Medicares Definition of DME Differ Compared to Medicaid?
Since Medicaid is a partnership between the federal government and the states, some Medicaid criteria – – like the DME definition – – is left for regulation by each state. By contrast, Medicare is totally federal and has one DME definition that applies nationwide. Medicare’s four-part definition of DME is very similar to New York’s Medicaid definition on parts one, two and three (see page 248). However, at part four it differs in that the equipment must be “appropriate for use in the home.” This phrase has been interpreted by the federal Centers for Medicare and Medicaid Services as meaning that the requested device or equipment must be needed for use within the home and that any benefit outside the home is allowed but not relevant to whether the individual qualifies for the device. This interpretation can affect both what is considered to be DME and what is considered to be medically necessary. Do not confuse this definition with Medicaid’s.
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