Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Ch. 5 § 20
Hospital Defined
20 - Hospital Defined
(Rev. 42, Issued: 11-09-06, Effective: N/A, Implementation: 12-11-06)
A hospital (other than psychiatric) means an institution which is primarily engaged in
providing, by or under the supervision of physicians, to inpatients, diagnostic and
therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or
sick persons; or rehabilitation services for the rehabilitation of injured, disabled, or sick
persons.
To be eligible to participate in Medicare, a hospital must also be an institution which:
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Maintains clinical records on all patients;
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Has bylaws in effect with respect to its staff of physicians;
•
Has a requirement that every patient must be under the care of a physician;
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Provides 24-hour nursing service rendered or supervised by a registered
professional nurse, and has a licensed practical nurse or registered professional
nurse on duty at all times;
•
Has in effect a hospital utilization review plan;
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Is licensed or is approved by the State or local licensing agency as meeting the
standards established for such licensing; and
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Meets other health and safety requirements found necessary by the Secretary of
Health, and Human Services. (These additional requirements may not be higher
than comparable ones prescribed for accreditation by the Joint Commission on
Accreditation of Hospitals with exceptions specified in the law).
Such an institution, if approved to participate as a hospital, may also be approved as a
swing bed facility pursuant to demonstration authority or if the hospital is a rural hospital
with less than 100 beds. (See §30.3 below.)