Defining Hospital for Spell of Illness, DME, and Home Health

2162 - Defining Hospital for Spell of Illness, DME, and Home Health Benefit Purposes (Rev. 1, 05-21-04) The term “hospital” as used in §1861(e) of the Act and State licensure laws has a generally accepted meaning that is seldom questioned. A problem arises, however, with respect to distinct parts of hospitals that render types of care other than hospital care (e.g., LTC). For example, a hospital may have separate wings or buildings for services ranging from residential to skilled nursing services. The SA evaluates these non-hospital parts in terms of whether they meet the definition of “hospital” in §1861(e)(1) of the Act. The SA also states whether these parts meet the definition of “skilled nursing facility” in §1819(a)(1) of the Act. Although a psychiatric hospital is precluded from participating in the Medicare program as a SNF, the spell of illness test is applied to such institution, and any non-hospital portions must be certified for spell of illness purposes.