CMS Pub. 100-02, ch. 4, § 10.2

A3-3104.2, HO-217.2

The status of a psychiatric hospital (or a distinct part of such a hospital) as of the

individual's first day of entitlement is controlling in determining whether days spent there

during the preceding 150 days are to be deducted. Thus, deductions would be made for

days spent in a hospital (or distinct part) that was participating as of the individual's first

day of entitlement even though it was not participating during all or part of the preceding

150 days. However, where an institution is not participating as of the individual's first

day of entitlement, deductions would not be made for days spent in that institution during

the preceding 150 days, even though the institution is later certified for participation as a

psychiatric hospital.

Where a participating psychiatric hospital is a distinct part of an institution, deductions

are made only for days spent in the wards, floors, wings, etc., included in the

participating distinct part as of the individual's first day of entitlement, even though it was

not participating during all or part of the preceding 150 days. Deductions are not made

for days spent in a part of the institution not included in the participating distinct part as

of the individual's first day of entitlement, e.g., days spent in a custodial section of the

institution or days spent in a general medical-surgical facility participating as a general

hospital.

EXAMPLE l:

Alice was admitted to Spring Psychiatric Hospital, which is a participating hospital, on

January 2 and discharged January 31. She was admitted to General Mental Health

Hospital, which is not a Medicare participating hospital, on March 1 through March 30.

On March 31, Alice was admitted to Spring Psychiatric Hospital. Alice’s Medicare

became effective April 1. The pre-entitlement days deducted from Mary’s first benefit

period are those used during her stay in Spring Psychiatric Hospital, which is a Medicare

participating hospital. The pre-entitlement days used are 29 in January and 1 in March

for a total of 30. Therefore, Alice has 120 days remaining in her first benefit period.