A. General

If an individual is in a participating psychiatric hospital on the first day of their entitlement to hospital insurance, the number of inpatient benefit days in the first benefit period may be reduced. The days (not necessarily consecutive) on which they were an inpatient of a psychiatric hospital in the 150 day period immediately before the first day of entitlement, must be subtracted from the 150 days of inpatient hospital services for which they would otherwise be eligible in their first benefit period. Days spent in a general hospital for diagnosis or treatment of a psychiatric condition prior to entitlement will not reduce the patient's inpatient benefit days in their initial benefit period.

The reduction applies only to inpatient hospital services received in a psychiatric hospital, or in a general hospital if the individual is an inpatient of the general hospital primarily for the diagnosis or treatment of mental illness. Thus, for example, if a patient in a psychiatric hospital has no benefit days remaining because of the reduction, they may nevertheless be entitled to have payment made for up to 150 days of inpatient hospital services for a non-mental illness during their first benefit period.