TN 3 (12-23)

HI 00401.230 PPSDefinition of Emergency Services Hospital

An emergency services hospital is a nonparticipating hospital which meets the requirements of the law’s definition of a “hospital” relating to full-time nursing services and licensure under State or applicable local law. (A Federal hospital need not be licensed under State or local licensing laws to meet the definition of emergency hospital.) In addition, the hospital must be primarily engaged in providing, under the supervision of doctors of medicine or osteopathy, services of the type that HI 00401.225 describes in defining the term hospital, and must be primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care. (See requirement A. of the definition of an SNF in HI 00401.260.) Psychiatric and tuberculosis hospitals that meet the above hospital requirements can qualify as emergency hospitals. Inpatient hospital services and related physician and ambulance services furnished outside the United States are covered under certain limited conditions.

The determination of whether an emergency existed is made by the appropriate intermediary. Payment of claims for emergency is also made by intermediaries designated by CMS.

A stay in a hospital meeting these requirements meets the prior stay requirements for coverage of extended care services and, prior to 7 /1/81, for Part A home health services.

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HI 00401.230 - PPSDefinition of Emergency Services Hospital - 12/16/2023
Batch run: 12/16/2023