Nonparticipating Emergency Hospitals

2052 - Nonparticipating Emergency Hospitals (Rev. 1, 05-21-04) 2052A - Emergency Hospital Services (Rev. 1, 05-21-04) Any nonparticipating hospital meeting the definition of an emergency hospital for Medicare purposes may claim payment for emergency inpatient and outpatient diagnostic services furnished to Medicare patients. There are six statutory requirements that a hospital must meet to qualify as an emergency hospital (§1861(e)(1), (2), (3), (4), (5), and (7)). The hospital must: • Be primarily engaged in providing, by or under the supervision of physicians, to inpatients, diagnostic and therapeutic services or rehabilitation services; • Maintain clinical records on all patients; • Have bylaws in effect with respect to its staff of physicians; • Have a requirement that every patient must be under the care of a physician; • Provide 24-hour nursing service rendered or supervised by a registered professional nurse and have a licensed, practical, or registered professional nurse on duty at all times; and, • Be licensed or meet standards for licensing pursuant to State and local law. 2052B - Preparation of Initial Certification (Rev. 1, 05-21-04) • For the initial certification, the SA obtains a completed Hospital Request to Establish Eligibility, Form CMS-1514. The SA annotates at the top; “Emergency Hospital Services Only.” When possible, the SA evaluates the capability of an institution to meet the statutory requirements from information contained in State licensure files and other available State records or through previous contacts with the hospital. • The SA prepares a Form CMS-1539, completing items 3, 4, 6, 7, 9, 12, 13, and 16 - 18. 2052C - Recertification and Follow-Up (Rev. 1, 05-21-04) The SA maintains an emergency hospital listing on a continuous basis and annually recheck it to ensure that the certifications are still correct. If a hospital no longer meets the definition of an “emergency hospital,” the SA prepares a new Form CMS-1539.