Distinct Part Psychiatric Hospital

2048 - Distinct Part Psychiatric Hospital (Rev. 1, 05-21-04) 2048A - General (Rev. 1, 05-21-04) A psychiatric hospital may elect to participate in its entirety, or it may designate a distinct part and apply for Medicare participation of that portion only (see §1886(d)). The distinct part provisions of the law are designed to permit the participation of those identifiable sections of psychiatric hospitals that are adequately staffed, supervised, and equipped to provide active treatment on a continuing basis. The participating distinct part must meet the hospital CoPs and the two special CoPs and have appropriate treatment services available. Patients in the distinct part must be provided treatment that may reasonably be expected to improve their condition. The provisions for certification of distinct parts of psychiatric hospitals apply only where the entire institution is primarily for the treatment of mental illness. Thus, a psychiatric wing or building of a general hospital or of a large medical center or complex may not be certified as a “distinct part psychiatric hospital.” Such facilities are included in the certification of the institution of which they are an integral part. 2048B - Physical Identification (Rev. 1, 05-21-04) To qualify for participation as a distinct part psychiatric hospital, the distinct part must be physically distinguishable from the larger institution or institutional complex; that is, a group of beds specifically for patients who need active treatment. The section(s) or unit(s) to be included in the distinct part certification must be clearly defined. An institution or institutional complex can only be certified with one distinct part. Multiple certifications within the institution or institutional complex are strictly prohibited. The distinct part can be a wing, separate building, a floor, a hallway, or one side of a corridor. The beds in the certified distinct part area must be physically separate from (that is, not commingled with) the beds of the institution or institutional complex in which it is located. However, the distinct part need not be confined to a single location within the institution or institutional complex’s physical plant. It may, for example, consist of several floors or wards in a single building or floors or wards that are located throughout several different buildings within the institutional complex. Where an institution or institutional complex owns and operates a distinct part, that distinct part is a single distinct part even if it is operated at various locations throughout the institution or institutional complex. The aggregate of the locations represents a single distinct part subprovider, not multiple subproviders, and must be assigned a single provider number. Specialized services such as physical therapy and occupational therapy services may be included in the distinct part certification. If any specialized services are included in the distinct part, the SA surveys the service and identifies them on Form CMS-1539. 2048C - Documentation of Findings (Rev. 1, 05-21-04) In the documentation on the survey report, the SA includes its observations about the distinct part and an assessment of the overall ability of the hospital to provide the services required. As appropriate, the SA must provide information about the entire hospital’s staffing pattern, such as the number, kind, and location of patient care personnel, including physicians, nursing personnel in all categories, social workers, and occupational and other therapists. The nonparticipating portion of an institution is required to meet the CoPs only insofar as it affects the health and safety of patients in the distinct part or provides facilities or services used by such patients. In certifying the distinct part, the SA considers the impact of nonparticipating sections of the institution to ascertain whether there are any hazardous conditions which might endanger patients in the distinct part; for example, the lack of adequate fire or sanitation safeguards, particularly where the distinct part is attached to the rest of the institution. It is rare that a distinct part of a hospital is completely self-contained. Therefore, the SA evaluates services, facilities, and activities of the overall institution that are provided or made available to patients throughout the institution. Inpatients of the distinct part may receive specialized services such as physical therapy or occupational therapy in a portion of the hospital not included in the distinct part. Services and facilities that may be shared vary with the type and size of the institution and the size of the distinct part. However, in most instances, the distinct part shares with the rest of the institution such central support services as dietary, housekeeping, maintenance, administration and supervision, and some medical and therapeutic services. The primary consideration in evaluation of shared services is whether the sharing can be done without sacrifice to the quality of care given the patients in the distinct part and without endangering their health and safety. Where personnel assignments are shared, the SA should show the extent of sharing. The SA verifies copies of staffing patterns and assignments furnished by the institution through personal observation, interviews with various personnel, examination of job descriptions and personnel records, and inspection of patient clinical records. The SA reviews medical records for an indication of the extent to which patients of the distinct part receive the services of skilled personnel. In general, the distinct part, either by itself or in conjunction with the overall institution of which it is a part, must be able to demonstrate the capacity to provide the services, facilities, and supervision required by the CoPs to patients of the distinct part.