General Information on IPPS Exclusion Deemed Providers and

3102 - General Information on IPPS Exclusion Deemed Providers and Suppliers (Rev. 198, Issued: 01-17-20, Effective: 01-17-20, Implementation: 01-17-20) The following providers and units are excluded from the Inpatient Prospective Payment System (IPPS): • Psychiatric hospitals; • Rehabilitation hospitals; • Children’s hospitals; • Long-term care hospitals; • Psychiatric and rehabilitation units of hospitals; • Cancer hospitals; and • CAHs. Certain kinds of Medicare-participating hospitals are paid under special provisions and are never subject to the IPPS. These hospitals need not be evaluated for compliance with the IPPS exclusion criteria: • Hospitals paid under State cost control systems approved by CMS; • Hospitals paid under demonstration projects approved by CMS; As of the cost reporting period beginning on or after October 1, 2019, an IPPS-excluded hospital is no longer precluded from having an IPPS-excluded psychiatric and/or rehabilitation unit. For the purposes of payment, services furnished by a unit are considered to be inpatient hospital services provided by the unit and not inpatient hospital services provided by the hospital operating the unit. Although an IPPS-excluded hospital may have an IPPS-excluded unit, the excluded hospital may not have an IPPS-excluded unit of the same type (psychiatric or rehabilitation) as the hospital (for example, an Inpatient Rehabilitation Facility (IRF) may not have an IRF unit). Note that a co-located, separately certified hospital or a separately certified hospital- within a hospital (HwH) is not a component of the hospital with which it shares a campus. For example, if a separately certified Medicare-participating short-term acute care IPPS hospital is located in the same building as a psychiatric hospital, it is not considered part of the psychiatric hospital and is not excluded from the IPPS based on the exclusion of the psychiatric hospital. It is important to note that payment rules, such as the HwH (42 CFR 412.22(e)) or satellite facility (412.22(h)) rules, never waive or supersede the requirement that all hospitals must comply with the hospital conditions of participation (CoPs). All hospitals, regardless of payment status, must always demonstrate separate and independent compliance with the hospital CoPs, even when an entire hospital or a part of a hospital is located in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital. An IPPS-excluded hospital operating an IPPS-excluded unit must continue to be in compliance with other Medicare regulations and CoPs applicable to the hospital and unit. An IPPS-excluded unit within a hospital is part of the hospital. Noncompliance with any of the hospital CoPs at 42 CFR 482.1 through 482.58 in any part of the certified hospital is noncompliance for the entire Medicare-certified hospital. Therefore, noncompliance with the hospital CoPs in an IPPS-excluded unit is noncompliance for the entire certified hospital (see 83 FR at 41514).