In addition to the benefit period requirement, the law specifies that the home health
visits must take place in the year following the most recent discharge from a covered
SNF stay of any duration or from a medically necessary stay of at least three consecutive
A participating general, psychiatric or tuberculosis hospital; or
a participating distinct part of a psychiatric or tuberculosis hospital, or
a nonparticipating general, psychiatric, or tuberculosis hospital which meets at least
the conditions of participation for a hospital, i.e., an emergency services hospital.
A nonparticipating psychiatric or tuberculosis hospital need not meet the special
requirements applicable to psychiatric and tuberculosis hospitals. Federal hospitals
need not be licensed under State or local laws to meet the prior stay hospital definition.
Stays in Christian Science Sanatoriums are excluded for the purpose of satisfying
the prior inpatient stay requirement.
The three consecutive calendar days requirement can be met by stays totalling three
consecutive days in one or more hospitals. In determining whether the requirement
has been met, the day of admission, but not the day of discharge is counted as a hospital
inpatient day. There must be an actual discharge of the patient from the hospital
or SNF to his residence. See HI 00601.300 for conditions under which an institution may not be considered the patient's residence.
The discharge from the hospital which is required to qualify home health services
for payment under HI must have occurred on or after the first day of the month in
which the patient attained age 65.