Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1163 - INPATIENT HOSPITAL SERVICES › Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM › GENERAL PROVISIONS › Section 1163.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
						subchapter, have the following meanings, unless the context clearly indicates
						otherwise:
APR-DRG
-All Patient Refined Diagnosis
						Related Group.
Buildings
-The basic structure or shell
						and additions thereto.
Children's hospital
-A hospital in which
						50% or more of the inpatients are 17 years of age or younger.
DRGs
or
diagnosis related
						groups
-A patient classification system that reflects clinically
						cohesive groupings of patients that consume similar amounts of hospital
						resources.
Day of inpatient hospital care
-Room,
						board and professional services furnished to a patient on a continuous
						24-hour-a-day basis in a semi-private room of a hospital. The term includes
						items and services ordinarily furnished by the hospital for the care and
						treatment of inpatients provided in an institution other than one maintained
						primarily for treatment and care of patients with tuberculosis or mental
						disease.
Fixtures
-Attachments to buildings such
						as wiring, electrical fixtures, plumbing, elevators, heating systems, air
						conditioning systems and the like. The general characteristics of fixtures are
						that they are affixed to the building and not subject to transfer and that they
						have a fairly long life, but shorter than the life of the building to which
						they are affixed.
Hospital
-A facility licensed as a
						hospital under 28 Pa. Code Part IV, Subpart B (relating to general and special
						hospitals) which provides equipment and services primarily for inpatient care
						to persons who require treatment for injury, illness, disability or pregnancy.
						The term does not include rehabilitation hospitals, public or private
						psychiatric hospitals, drug and alcohol rehabilitation hospitals, general
						nursing facilities, hospital-based nursing facilities, county-operated nursing
						facilities, intermediate care facilities for the mentally retarded, psychiatric
						transitional facilities or special rehabilitation nursing facilities.
Hospital admission
-The formal acceptance
						of a patient to a hospital inpatient setting for purposes of providing
						inpatient hospital services.
Inpatient hospital services
-Services,
						other than those provided by an institution for tuberculosis or mental
						diseases, which are ordinarily furnished in a hospital for the care and
						treatment of inpatients. Inpatient hospital services exclude services provided
						in a short procedure unit, direct care practitioners' services and direct care
						midwives' services. Inpatient hospital services are furnished under the
						direction of a licensed physician, dentist, podiatrist or nurse-midwife.
Institutionalized individual
-A person
						who is detained or confined under one of the following:
(i) A civil or criminal statute in a
					 correctional, rehabilitative or mental retardation facility, psychiatric
					 hospital or other facility for the care and treatment of mental illness or
					 mental retardation.
(ii) Voluntary
					 commitment in a psychiatric hospital, mental retardation facility or other
					 facility for the care and treatment of mental illness or mental
					 retardation.
Normal newborn
-A liveborn neonate whose
						diagnosis is categorized into severity level 1 of the newborn APR-DRG 640 as of
						July 1, 2011.
Outlier
-An inpatient hospital case
						having either an extremely long length of stay or extraordinarily high costs in
						comparison to most discharges for the same DRG.
Patient pay amount
-Income or assets that
						a recipient has available to meet the cost of medical care as determined by the
						CAO. The recipient, not the MA Program, pays this amount toward the cost of
						care.
Therapeutic leave
-A period of absence
						from the hospital related to the treatment of an individual's illness.
The provisions of this §
													1163.2 amended under sections
						  201(2), 403(b) and 403.1 of the Public Welfare Code (62 P. S. §§
														201(2),
						  403(b) and
						  403.1).
This section cited in 55 Pa. Code §
													1151.54 (relating to
						  disproportionate share payments); 55 Pa. Code §
													1163.51 (relating to general
						  payment policy); 55 Pa. Code §
													1163.52 (relating to prospective
						  payment methodology); 55 Pa. Code §
													1163.67 (relating to
						  disproportionate share payments); and 55 Pa. Code §
													1163.459 (relating to
						  disproportionate share payments).