Title 42, Part 409 — Hospital Insurance Benefits

Statutory basis.

Scope.

Definitions.

General description of benefits.

Included services.

Bed and board.

Nursing and related services, medical social services; use of hospital or CAH facilities.

Drugs and biologicals.

Supplies, appliances, and equipment.

Services furnished by an intern or a resident-in-training.

Other diagnostic or therapeutic services.

Physical therapy, occupational therapy, and speech-language pathology services.

Services related to kidney transplantations.

Coverage of services.

Nursing care.

Bed and board.

Physical therapy, occupational therapy, and speech-language pathology services.

Medical social services.

Drugs, biologicals, supplies, appliances, and equipment.

Transfer agreement hospital services.

Other services generally provided by (or under arrangements made by) SNFs.

Basic requirements.

Level of care requirement.

Criteria for skilled services and the need for skilled services.

Examples of skilled nursing and rehabilitation services.

Criteria for “daily basis”.

Criteria for “practical matter”.

Effect of discharge from posthospital SNF care.

Basis, purpose, and scope.

Requirement for payment.

Beneficiary qualifications for coverage of services.

Plan of care requirements.

Skilled services requirements.

Dependent services requirements.

Allowable administrative costs.

Place of service requirements.

Visits.

Excluded services.

Coinsurance for durable medical equipment (DME) and applicable disposable devices furnished as a home health service.

Benefit periods.

General limitations on amount of benefits.

Lifetime maximum on inpatient psychiatric care.

Reduction of inpatient psychiatric benefit days available in the initial benefit period.

Services that are counted toward allowable amounts.

Lifetime reserve days.

Revocation of election not to use lifetime reserve days.

Guarantee of payment for inpatient hospital or inpatient CAH services furnished before notification of exhaustion of benefits.

Inpatient deductible and coinsurance: General provisions.

Inpatient hospital deductible.

Inpatient hospital coinsurance.

Skilled nursing facility (SNF) care coinsurance.

Blood deductible.

Exemption of kidney donors from deductible and coinsurance requirements.

To whom payment is made.

Amounts of payment.