Page 17 - Medicare Benefit Policy Manual

furnish end-stage renal disease (ESRD) services to nonveterans may be
considered community hospitals with respect to any otherwise covered service
rendered to ESRD beneficiaries. This exception does not apply to Federal clinics
or other Federal health facilities which are not “providers of services” as defined
in the Medicare law, i.e., which are not hospitals, SNFs, HHAs or CORFs. The
CMS is responsible for processing claims for services furnished directly by
Federal providers. If the A/B MAC (A) were to receive a request for Medicare
reimbursement of such services it would forward the request to:

Centers for Medicare & Medicaid Services
Office of Financial Management
P.O. Box 17255
Baltimore, Maryland 21203-7255

NOTE: The VA copayment provisions mentioned in §50.1.1 also applies to inpatient
services furnished in a VA hospital. Should the A/B MAC (A) receive a request for
Medicare reimbursement of VA copayment amounts for emergency services furnished by
VA hospitals, it would refer the request to CMS.

50.3 - Items or Services Paid for by Governmental Entity
(Rev. 1, 10-01-03)
A3-3153.3, HO-260.3.C, B3-2309.4

Medicare payment may not be made for items or services paid for directly or indirectly
by a Federal, State or local governmental entity. However, the law specifies that this
exclusion does not prohibit payment for:

• Items or services furnished under a health benefits or insurance plan established
for employees of the governmental entity;

• Items or services furnished under one of the titles of the Social Security Act (such
as medical assistance under title XIX); or

• Rural health clinic services.

50.3.1 - Application of Exclusion to State and Local Government
Providers

(Rev. 1, 10-01-03)
A3-3153.3.A, HO-260.3.C

Except for the two categories of facilities referred to below, payment may not be made
for items and services which a State or local government facility furnishes free of charge,
i.e., without expectation of payment from any source and without regard to the
individuals’ ability to pay. A facility which reduces or waives its charges for patients
unable to pay, or charges patients only to the extent of their Medicare and other health