§ 1163.402. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Certified day—A day of inpatient hospital care approved by the Department, under the limits established in this chapter.
Day of inpatient hospital care—Room, board and professional services furnished to a patient on a continuous 24-hour-a-day basis in a semiprivate room of a hospital. The term includes items and services ordinarily furnished by the hospital for the care and treatment of inpatients provided in an institution other than one maintained primarily for treatment and care of patients with tuberculosis or mental disease.
Drug and alcohol rehabilitation hospital—A freestanding entity which meets the definition of a hospital under this section, and is licensed by the Department of Health to provide drug and alcohol treatment and rehabilitation.
Drug and alcohol rehabilitation unit—A unit of an acute care general hospital which is licensed by the Department of Health to provide drug and alcohol treatment and rehabilitation.
Hospital—A facility licensed as a hospital under 28 Pa. Code Part IV, Subpart B (relating to general and special hospitals) which provides equipment and services primarily for inpatient care to persons who require treatment for injury, illness, disability or pregnancy. The term does not include public or private psychiatric hospitals, general nursing facilities, hospital-based nursing facilities, county-operated nursing facilities, intermediate care facilities for the mentally retarded, psychiatric transitional facilities or special rehabilitation nursing facilities.
Inpatient hospital services—Services other than those provided by an institution for tuberculosis or mental diseases which are ordinarily furnished in a hospital for the care and treatment of inpatients, furnished under the direction of a licensed physician, dentist, podiatrist or nurse-midwife.
Institutionalized individual—A person who is detained or confined under one of the following:(i) A civil or criminal statute in a correctional, rehabilitative or mental retardation facility, psychiatric hospital or other facility for the care and treatment of mental illness or mental retardation.
(ii) Voluntary commitment in a psychiatric hospital, mental retardation facility or other facility for the care and treatment of mental illness or mental retardation.
Medical rehabilitation hospital—A freestanding entity which meets the definition of a hospital under this section, and participates in the Medicare Program as an excluded rehabilitation hospital or, for children’s hospitals only, meets the Medicare requirements for an excluded rehabilitation hospital in 42 CFR 412.23(b) (relating to excluded hospitals classifications).
Medical rehabilitation unit—A distinct part unit of a general hospital which: is recognized as an excluded rehabilitation unit under the Medicare Program; has formally applied to Medicare for exclusion from the prospective payment system and is undergoing the 12-month evaluation period; or, for the children’s hospitals only, would meet the Medicare definition of excluded rehabilitation unit if the unit chose to apply for Medicare exclusion. For the purposes of this subchapter, units that are organized primarily for the treatment of burns are not included, but will continue to be reimbursed subject to Subchapter A and Chapter 1101 (relating to acute care general hospitals under the prospective payment system; and general provisions).
Patient pay amount—Income or assets that a recipient has available to meet the cost of medical care as determined by the CAO. The recipient, not the MA Program, pays this amount toward the cost of care.
Rehabilitation hospital—A hospital which meets the definition of either a drug and alcohol rehabilitation hospital or a medical rehabilitation hospital under this section.
Therapeutic leave—A period of absence from the hospital related to the treatment of an individual’s illness.
Authority The provisions of this § 1163.402 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1)).
Source The provisions of this § 1163.402 adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185; amended June 16, 1989, effective immediately and applies retroactively to July 1, 1988, 19 Pa.B. 2563; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial pages (181858) to (181860).
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