HI 00401.245 Certification of Parts of Institutions as Hospitals

Under certain conditions a distinct part of a tuberculosis or psychiatric institution may be certified as a tuberculosis psychiatric, or general hospital.

A. Part of a psychiatric institution as a psychiatric hospital

A distinct part of a psychiatric institution can be certified as a psychiatric hospital if it meets the conditions of participation even though the institution of which it is a part does not. If the distinct part meets requirements equivalent to the accreditation requirements of the JCAH, it can qualify under the program even though the institution itself is not accredited.

B. General hospital facility of psychiatric hospital

A general hospital facility within a psychiatric hospital may be certified as a general hospital independent of the institution as a whole provided the general facility is a self-contained operational entity distinct from the rest of the institution. The general hospital facility would be regarded as a separate institution for this purpose since the law does not provide for certifying a “distinct part” of an institution as a general hospital. Services furnished in a separately certified general hospital facility are not subject to any of the benefit limitations applicable to the other parts of the institution, i.e., the reduction in benefit days in the first spell of illness in the case of psychiatric hospitals and the 190 day lifetime maximum on inpatient services in the case of psychiatric hospitals.

C. Part of a general hospital as a psychiatric hospital

There is no provision for a psychiatric wing of a general hospital to be certified as a psychiatric hospital. The distinct part provisions apply only to psychiatric institutions and not to general hospitals. However, this does not prevent the certification of a psychiatric hospital which is a part of a medical center or other large complex, provided the hospital operates as a separate functioning entity, i.e., it is located in a separate building, wing, or part of a building, has its own administration and maintains separate fiscal records.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600401245
HI 00401.245 - Certification of Parts of Institutions as Hospitals - 04/06/2015
Batch run: 04/06/2015
Rev:04/06/2015