Admission of Medicare Patients for Care and Treatment

10.2 - Admission of Medicare Patients for Care and Treatment (Rev. 120, Issued: 11-02-18, Effective: 12- 04-18, Implementation: 12- 04-18 The participation of a provider of services, which voluntarily files an agreement to participate in the health insurance program, contemplates that such provider will admit Medicare beneficiaries for care and treatment, and upon admission, will provide them with such services as are ordinarily furnished by the provider to its patients generally. A provider may have restrictions on the types of services it makes available and/or the types of health conditions it accepts, or may establish other criteria relating to the admission of persons for care and treatment. However, the law does not contemplate that such restrictions or criteria will apply only to Medicare beneficiaries as a class. It does contemplate, however, that if such restrictions or criteria apply to Medicare beneficiaries, they will be applied in the same manner in which they are applied to all other persons seeking care and treatment by the provider. Thus, a provider admission or patient policy or practice which is not consistent with the objective contemplated in the law may be used by CMS as a basis for termination of the agreement for cause (see the regulations at 42 CFR 489.53(a)(2), and also see Pub. 100-04, Medicare Claims Processing Manual, chapter 1, §30.1.3).