US · guidance
CMS Pub. 100-16, ch. 8, § 120
Special Rules for Coverage That Begins or Ends During an
Inpatient Hospital Stay
(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)
Applicability. Per 42 CFR 422.318, this provision applies to inpatient services in a
subsection (d) hospital as defined in §1886(d)(1)(B) of the Act, a psychiatric hospital
described in §1886(d)(1)(B)(i) of the Act, a rehabilitation hospital described in
§1886(d)(1)(B)(ii) of the Act, a distinct part rehabilitation unit described in the matter
following clause (v) of §1886(d)(1)(B) of the Act, or a long-term care hospital (described
in §1886(d)(1)(B)(iv)).
Coverage that begins during an inpatient stay. If coverage under an MA plan offered
by an MA organization begins while the beneficiary is an inpatient in one of the facilities
described under Applicability:
• Payment for inpatient hospital services continues to be the responsibility of
original Medicare or the previous MA organization, as appropriate, until the
date of the beneficiary’s discharge.
• The MA organization offering the newly elected MA plan is not financially
responsible for the inpatient hospital services until the date after the
beneficiary’s discharge. Original Medicare or the previous MA organization
is financially responsible for inpatient hospital services for that beneficiary for
that inpatient episode, even if it extends beyond the effective date of a
beneficiary’s MA election.
• The MA organization offering the newly-elected MA plan is paid the full
amount otherwise payable under Part C.
Coverage that ends during an inpatient stay. In the case where a beneficiary’s MA plan
election ends while he or she is a hospital inpatient, the MA organization remains
responsible for payment for inpatient hospital services furnished by a hospital after
expiration of enrollment until the date of discharge. Payment for these services would not
be made by original Medicare under Medicare’s PPS system. The MA organization that no
longer enrolls the member receives no payment from CMS or the beneficiary for the period
after coverage ends.
History
(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9aac67be1e6c58d30120390679c30bb353b464ffff57d9521840d0f2888e359b
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.