If a patient is discharged to a behavior management unit that is hospital-based, is this considered acute care and can she be brought back in on Medicare Part A?

Q: If a patient is discharged to a behavior management unit that is hospital-based, is this considered acute care and can she be brought back in on Medicare Part A? Can this type of unit be considered as a qualifying three-night hospital stay?

A: If the patient is admitted to either a Medicare participating general hospital or a participating psychiatric hospital, it would be considered acute care for Medicare Part A per the Medicare regulations (100-02 Medicare Benefits Policy Manual, Ch. 8, §20.1), which specify:

  • The qualifying hospital stay must have been medically necessary
  • A three-day stay in a psychiatric hospital satisfies the prior hospital stay requirement; however, institutions (including a SNF) that primarily provide psychiatric treatment are not allowed to participate in the program as a SNF. Therefore, a patient with only a psychiatric condition who is transferred from a psychiatric hospital to a participating SNF is likely to receive only non-covered care.

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