Medicare Benefit Policy Manual (Pub. 100-02), Ch. 2 § 20
Admission Requirements
20 - Admission Requirements
(Rev. 253, Issued: 12- 14-18, Effective: 01-16-19, Implementation: 01- 16-19)
In accordance with 42 CFR 412.27(c), for all IPFs, a provisional or admitting diagnosis
must be made on every patient at the time of admission, and must include the diagnosis
of comorbid conditions as well as the psychiatric diagnosis. The reasons for admission
must be clearly documented as stated by the patient or others significantly involved, or
both.
Psychiatric hospitals are required to be primarily engaged in providing, by or under the
supervision of a psychiatrist, psychiatric services for the diagnosis and treatment of
mentally ill persons, according to 42 CFR 412.23(a). Distinct part psychiatric units of
acute care hospitals and CAHs are required to admit only those patients whose admission
to the unit is required for active treatment, of an intensity that can be provided
appropriately only in an inpatient hospital setting, of a psychiatric principal diagnosis that
is listed in the International Classification of Diseases, Tenth Revision, Clinical
Modification.
As a condition for Medicare payment, all admissions to IPFs must be certified and
recertified by a physician, as detailed in section 30.2.1.