Criteria for Continued Inpatient Hospital Stay

10.6 - Criteria for Continued Inpatient Hospital Stay (Rev. 94, Issued: 10-16-15, Effective: 11-16-15, Implementation: 11-16-15) A physician who certifies or recertifies to the need for continued inpatient stay should use the same criteria that apply to the hospital's utilization review committee. These criteria include not only medical necessity, but also the availability of out-of-hospital facilities and services which will assume continuity of care. In accordance with the regulations at 42 CFR 424.13(c), a physician should certify or recertify need for continued hospitalization if the physician finds that the patient could receive treatment in a SNF but no bed is available in the participating SNF. Where the basis for the certification or recertification is the need for continued inpatient care because of the lack of SNF accommodations, the certification or recertification should so state. The physician is expected to continue efforts to place the patient in a participating SNF as soon as the bed becomes available. Coverage of these additional, “alternate placement” days in the hospital can continue until the earliest of the following events occurs: • A bed becomes available in a participating SNF; • The beneficiary’s care needs drop below SNF-level; or • The beneficiary has exhausted all of the available days of Part A inpatient hospital benefits in that benefit period.