Haw. Code R. § 17-1737-3 - Inpatient hospital care

(a) Inpatient hospital care means services that are ordinarily furnished in a hospital for the care and treatment of inpatients under the direction of a physician, podiatrist, or dentist and which is furnished by an institution meeting the following requirements:

(1) Is not maintained primarily for the treatment of tuberculosis, mental diseases, or Hansen's disease;

(2) Is licensed as a hospital by the State;

(3) Meets the requirements for medicare participation; and

(4) Has in effect a utilization review plan approved by the department.

(b) Inpatient hospital care shall include the following:

(1) Ward or semiprivate accommodations including bed and meals, or a private room when medically indicated;

(2) Nursing care;

(3) Drugs, dressings, and diagnostic and therapeutic procedures as prescribed by the attending physician; and

(4) Other ancillary services associated with hospital care except private duty nursing.

(c) The department shall not pay for inpatient hospital care in the following instances:

(1) Patients whose medical needs do not require admission for acute inpatient care;

(2) Diagnostic procedure which may be performed on an outpatient basis;

(3) Personal comfort items furnished by the hospital; and (4) Partial hospitalization, day, evening, or night care, except for a patient receiving a surgical procedure or test which would permit return to the patient's home on the same day.

Notes

Haw. Code R. § 17-1737-3

[Eff 08/01/94] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §440.10)