POMS Reference

HI 00401: Provider and Related Definitions

Citations:

Social Security Act—Sec. 1861(e),(f),(g)

Regulations No. 5—Secs. 405.1011-405.1040

A hospital (other than tuberculosis or psychiatric) means an institution which:

  1. Is primarily engaged in providing, by or under the supervision of physicians, to inpatients:

    1. Diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or

    2. Rehabilitation services for the rehabilitation of injured, disabled, or sick persons;

  2. Maintains clinical records on all patients;

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

  4. Has a requirement that every patient must be under the care of a physician;

  5. Provides 24-hour nursing service rendered or supervised by a registered professional nurse, and has a licensed practical nurse or registered professional nurse on duty at all times;

  6. Has in effect a hospital utilization review plan;

  7. Is licensed or is approved by the State or local licensing agency as meeting the standards established for such licensing;

  8. Meets other health and safety requirements found necessary by the Secretary of Health and Human Services. (These additional requirements may not be higher than comparable ones prescribed for accreditation by the Joint Commission on Accreditation of Hospitals (JCAH) with exceptions specified in the law.)

  9. Is not primarily for the care and treatment of mental diseases or tuberculosis.

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