US · guidance
CMS Pub. 100-01, ch. 3, § 10.4.3
Definition of Hospital or SNF for Ending a Benefit Period
It is important to note that a benefit period cannot end while a beneficiary is an inpatient
(see §10.4.4) of an institution that meets the basic definition of a “hospital” at
§1861(e)(1) of the Social Security Act (the Act), even if the hospital does not meet all of
the additional requirements that are necessary for starting a benefit period, as discussed
further in §10.4.3.1 below (see also §1861(e) following (9) of the Act and the regulations
at 42 CFR 409.60(b)(1)). Similarly, a benefit period cannot end while a beneficiary is an
inpatient (see §10.4.4) of an institution that meets the basic definition of a “SNF” at
§1819(a)(1) of the Act, as discussed further in §10.4.3.2 below.
As noted in §2164 of the State Operations Manual (Pub. 100-07), Chapter 2, all hospitals
and SNFs that are Medicare-certified are automatically considered to meet the applicable
basic definition in this context by reason of the Medicare certification itself. Moreover,
even an institution (or portion of an institution) that is not certified for Medicare can
serve to prolong an inpatient’s benefit period if it meets either the basic “hospital” or
“SNF” definition discussed above.
History
(Rev.10880, Issued: 08-06-21, Effective: 11-08- 21, Implementation: 11-08-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5f813a8886aeda2d0d86d66f5702c3110864edc8fa3a8f6daee4bd72b05a4563
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