Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1163 - INPATIENT HOSPITAL SERVICES › Subchapter B - HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES › GENERAL PROVISIONS › Section 1163.402 - 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:
Certified day
-A day of inpatient
						hospital care approved by the Department, under the limits established in this
						chapter.
Day of inpatient hospital care
-Room,
						board and professional services furnished to a patient on a continuous
						24-hour-a-day basis in a semiprivate 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.
Drug and alcohol rehabilitation
						hospital
-A freestanding entity which meets the definition of a
						hospital under this section, and is licensed by the Department of Health to
						provide drug and alcohol treatment and rehabilitation.
Drug and alcohol rehabilitation unit
-A
						unit of an acute care general hospital which is licensed by the Department of
						Health to provide drug and alcohol treatment and rehabilitation.
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 public or private psychiatric 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.
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, 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.
Medical rehabilitation hospital
-A
						freestanding entity which meets the definition of a hospital under this
						section, and participates in the Medicare Program as an excluded rehabilitation
						hospital or, for children's hospitals only, meets the Medicare requirements for
						an excluded rehabilitation hospital in
						42 CFR
						412.23(b) (relating to
						excluded hospitals classifications).
Medical rehabilitation unit
-A distinct
						part unit of a general hospital which: is recognized as an excluded
						rehabilitation unit under the Medicare Program; has formally applied to
						Medicare for exclusion from the prospective payment system and is undergoing
						the 12-month evaluation period; or, for the children's hospitals only, would
						meet the Medicare definition of excluded rehabilitation unit if the unit chose
						to apply for Medicare exclusion. For the purposes of this subchapter, units
						that are organized primarily for the treatment of burns are not included, but
						will continue to be reimbursed subject to Subchapter A and Chapter 1101
						(relating to acute care general hospitals under the prospective payment system;
						and general provisions).
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.
Rehabilitation hospital
-A hospital which
						meets the definition of either a drug and alcohol rehabilitation hospital or a
						medical rehabilitation hospital under this section.
Therapeutic leave
-A period of absence
						from the hospital related to the treatment of an individual's
						illness.
The provisions of this §
													1163.402 amended under sections
						  201 and 443.1(1) of the Public Welfare Code (62 P. S. §§
														201 and
						  443.1(1)).