B. Beginning a benefit period

A benefit period is a period of consecutive days that begins with the first day (not included in a previous spell of illness) on which a beneficiary is furnished inpatient hospital or extended care services by a qualified provider. THUS, GENERALLY, THE BENEFIT PERIOD BEGINS WHEN COVERED INPATIENT SERVICES ARE INITIALLY FURNISHED TO AN ENTITLED INDIVIDUAL.

A spell of illness may also begin with a stay in a qualified “emergency hospital” in Canada or Mexico when it furnishes the patient covered emergency inpatient hospital services or when it is more accessible for a border resident including nonemergency situations.

If a person is in a nonqualified institution and is subsequently transferred to a qualified hospital (general, psychiatric, or tuberculosis), the person's spell of illness begins on admission to the qualified hospital ( HI 00401.225 ).

Admission to a qualified SNF begins a benefit period even though payment for the services cannot be made under Part A because the prior hospitalization or transfer requirement has not been met.

For coverage of home health services only, prior to July 1, 1981, a benefit period begins when a beneficiary is admitted to a nonparticipating hospital that has Joint Commission on Accreditation of Hospital (JCAH) certification, or that of the American Osteopathic Association (AOA). This rule applies whether the hospital is within the United States or in a foreign country or whether the services are emergency or non-emergency.