2. Prior inpatient stay

In addition to the benefit period requirement, the law specifies that the home health visits must take place in the year following the most recent discharge from a covered SNF stay of any duration or from a medically necessary stay of at least three consecutive days in:

a. A participating general, psychiatric or tuberculosis hospital; or

b. a participating distinct part of a psychiatric or tuberculosis hospital, or

c. a nonparticipating general, psychiatric, or tuberculosis hospital which meets at least the conditions of participation for a hospital, i.e., an emergency services hospital.

A nonparticipating psychiatric or tuberculosis hospital need not meet the special requirements applicable to psychiatric and tuberculosis hospitals. Federal hospitals need not be licensed under State or local laws to meet the prior stay hospital definition. Stays in Christian Science Sanatoriums are excluded for the purpose of satisfying the prior inpatient stay requirement.

The three consecutive calendar days requirement can be met by stays totalling three consecutive days in one or more hospitals. In determining whether the requirement has been met, the day of admission, but not the day of discharge is counted as a hospital inpatient day. There must be an actual discharge of the patient from the hospital or SNF to the patient's residence. See HI 00601.300 for conditions under which an institution may not be considered the patient's residence.

The discharge from the hospital which is required to qualify home health services for payment under HI must have occurred on or after the first day of the month in which the patient attained age 65.