CMS Pub. 100-04, ch. 1, § 10.2.1

A. Beneficiary Services Outside United States - Emergency Hospital Admissions

See chapter 3, for detailed information concerning beneficiary services outside the United

States. Generally, payment is made for emergency inpatient hospital services in qualified

Canadian or Mexican hospitals in the following circumstances:

• A Medicare beneficiary is in the United States when an emergency occurs, and a

Canadian or Mexican hospital is closer to, or more accessible from, the site of the

emergency than the nearest adequately equipped United States hospital that can

provide emergency services, or

• The emergency occurred in Canada while the beneficiary is traveling between

Alaska and another State without unreasonable delay and by the most direct route,

and a Canadian hospital is closer to, or more accessible from, the site of the

emergency than the nearest United States hospital. For this purpose, an

emergency occurring within the Canadian inland waterway between the States of

Washington and Alaska is considered to have occurred in Canada.

The term “United States” means the 50 States, the District of Columbia, the

Commonwealth of Puerto Rico, the Virgin Islands, Guam, Northern Mariana Islands,

American Samoa and, for purposes of services furnished on a ship, the territorial waters

adjoining the land areas of the U.S.

A hospital that is not physically situated in one of the above jurisdictions is considered to

be outside the United States, even if it is owned or operated by the United States

Government.

B. Nonemergency Inpatient Services Furnished in Foreign Hospitals

If the beneficiary resides in the United States, and a Canadian or Mexican hospital is

closer to, or more accessible from, the beneficiary’s home than the nearest adequately

equipped United States hospital, Medicare will pay for covered services regardless of

whether an emergency exists. Residence means the place in the U.S. where a person has

a fixed and permanent home to which he intends to return whenever he is away. At the

time such services are furnished, the Canadian or Mexican hospital must be accredited by

the JCAH or by a hospital approval program of the country in which it is located having

standards essentially equivalent to those of the JCAHO.