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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that examples of inpatient psychiatric admission criteria include (but are not limited to): 
 
1. Threat to self-requiring 24-hour professional observation 
        a. suicidal ideation or gesture within 72 hours prior to admission 
        b. self-mutilation (actual or threatened) within 72 hours prior to admission. 
        c. chronic and continuing self-destructive behavior (e.g., bulemic behaviors, substance abuse) that poses a 
           significant and/or immediate threat to life, limb, or bodily function.  
 
 2. Threat to others requiring 24-hour professional observation: 
         a. assaultive behavior threatening others within 72 hours prior to admission. 
         b. significant verbal threat to the safety of others within 72 hours prior to admission. 
 
3. Command hallucinations directing harm to self or others where there is the risk of the patient taking action            
on them. 
 
4. Acute disordered/bizarre behavior or psychomotor agitation or retardation that interferes with the activities     
of daily living (ADLs) so that the patient cannot function at a less intensive level of care during evaluation and 
treatment.  

5. Cognitive impairment (disorientation or memory loss) due to an acute Axis I disorder that endangers the 
 welfare of the patient or others. 
 
6. For patients with a dementing disorder for evaluation or treatment of a psychiatric comorbidity (e.g., risk of 
    suicide, violence, severe depression) warranting inpatient admission. 
 
7. A mental disorder causing major disability in social, interpersonal, occupational, and/or educational          
functioning that is leading to dangerous or life-threatening functioning, and that can only be addressed in an 
acute inpatient setting. 
 
8. A mental disorder that causes an inability to maintain adequate nutrition or self-care, and family/community 
support cannot provide reliable, essential care, so that the patient cannot function at a less intensive level of 
care during evaluation and treatment. 
 
9. Failure of outpatient psychiatric treatment so that the beneficiary requires 24-hour professional observation 
and care. Reasons for the failure of outpatient treatment could include: 
       a. Increasing severity of psychiatric symptoms; 
       b. Noncompliance with medication regimen due to the severity of psychiatric symptoms; 
       c. Inadequate clinical response to psychotropic medications; 
       d. Due to the severity of psychiatric symptoms, the patient is unable to participate in an outpatient 
           psychiatric treatment program. 
  
You can find this information at Local Coverage Determination (LCD)-Psychiatric Inpatient Hospitalization 
(L33624). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.