CMS SOM App. A, Tag A-1600

Hospitals

Psychiatric hospitals must—

Interpretive Guidelines §482.60

A psychiatric hospital is defined in section 1861(f) of the Act as a hospital that is

primarily engaged in providing, by or under the supervision of a physician, psychiatric

services for the diagnosis and treatment of mentally ill persons and:

• Satisfies all of the requirements in sections 1861(e)(3) through (9) of the Act,

including that the hospital:

o Has bylaws in effect with respect to its staff of physicians;

o Has a requirement that every patient with respect to whom payment may

be made under this title must be under the care of a physician except that

a patient receiving qualified psychologist services may be under the care

of a clinical psychologist with respect to such services to the extent

permitted under State law;

o Provides 24-hour nursing services rendered or supervised by a

professional registered nurse, and has a licensed practical nurse or

registered professional nurse on duty at all times;

o Has in effect a hospital utilization review plan and has in place a

discharge planning process that meets the requirements of sections

1861(k) and (ee) of the Act, respectively;

o In the case of an institution in any State in which State or applicable local

law provides for licensing of hospitals, meets the standards established

for such licensing;

o Has in effect an overall plan and budget consistent with section 1861(z);

o Meets other such requirements as the Secretary finds necessary in the

interest of the health and safety of individuals who are furnished services

in the institution;

• Maintains clinical records on all patients and as the Secretary finds to be

necessary to determine the degree and intensity of the treatment provided to

individuals entitled to hospital insurance benefits under Medicare part A;

• Meets such staffing requirements as the Secretary finds necessary for the

institution to carry out an active program of treatment for the individuals who

are furnished services in the institution; and

• In the case of an institution which satisfies the requirements at section

1861(f)(1)-(2) and contains a distinct part which also satisfies the requirements

at section 1861(f)(3)-(4), the distinct part shall be considered to be a

“psychiatric hospital”.

• All patients in a psychiatric hospital must be receiving active treatment for their

psychiatric conditions. The active treatment requirement in psychiatric hospitals

applies to all patients regardless of the population served, acute or long-term

focus, or length of stay. Psychiatric hospitals do not provide residential

treatment.

Additionally, psychiatric hospitals are required to meet the hospital CoPs at §482.1

through §482.23 and §482.25 through §482.57, as well as the special CoPs for

psychiatric hospitals at §482.60, §482.61 and §482.62. The special conditions of

participation for psychiatric hospitals only apply to psychiatric hospitals. They do not

apply to psychiatric units of hospitals or critical access hospitals (CAHs), or Inpatient

Prospective Payment System (IPPS)-excluded psychiatric units in hospitals or distinct

part psychiatric units of CAHs.

If the psychiatric hospital provides any outpatient services, the services must comply with

the hospital outpatient services CoP at §482.54 (Tags A-1076 through A-1081). The

hospital outpatient services CoP at §482.54 requires that all outpatient services “must be

organized and integrated with inpatient services.” If the psychiatric hospital chooses to

provide outpatient psychiatric services, those services must be provided by or under the

supervision of a medical doctor or doctor of osteopathy (MD/DO).

Emergency services are optional services in hospitals, including psychiatric hospitals.

Psychiatric hospitals that provide emergency services are required to comply with the

Emergency Services CoP at §482.55, Tag A-0092, as well as the Emergency Medical

Treatment and Labor Act (EMTALA) requirements at §489.24 and the EMTALA-related

requirements at §489.20. Psychiatric hospitals may choose to offer emergency services,

which must be provided in a “dedicated emergency department,” as defined at

§489.24(b) and referenced in Tag A-0094. In the psychiatric hospital setting, emergency

services may be provided in an intake or assessment unit if the unit meets the listed

requirements in §489.24(b).