Title 42

PART 409

Part 409 - Hospital Insurance Benefits

PART 409 - HOSPITAL INSURANCE BENEFITS Authority:42 U.S.C. 1302 and 1395hh. Source:48 FR 12541, Mar. 25, 1983, unless otherwise noted. Editorial Note:Nomenclature changes to part 409 appear at 62 FR 46037, Aug. 29, 1997.

42:2.0.1.2.9.1SUBPART A
Subpart A - Hospital Insurance Benefits: General Provisions
42:2.0.1.2.9.1.35.1SECTION 409.1
   409.1 Statutory basis.
42:2.0.1.2.9.1.35.2SECTION 409.2
   409.2 Scope.
42:2.0.1.2.9.1.35.3SECTION 409.3
   409.3 Definitions.
42:2.0.1.2.9.1.35.4SECTION 409.5
   409.5 General description of benefits.
42:2.0.1.2.9.2SUBPART B
Subpart B - Inpatient Hospital Services and Inpatient Critical Access Hospital Services
42:2.0.1.2.9.2.35.1SECTION 409.10
   409.10 Included services.
42:2.0.1.2.9.2.35.2SECTION 409.11
   409.11 Bed and board.
42:2.0.1.2.9.2.35.3SECTION 409.12
   409.12 Nursing and related services, medical social services; use of hospital or CAH facilities.
42:2.0.1.2.9.2.35.4SECTION 409.13
   409.13 Drugs and biologicals.
42:2.0.1.2.9.2.35.5SECTION 409.14
   409.14 Supplies, appliances, and equipment.
42:2.0.1.2.9.2.35.6SECTION 409.15
   409.15 Services furnished by an intern or a resident-in-training.
42:2.0.1.2.9.2.35.7SECTION 409.16
   409.16 Other diagnostic or therapeutic services.
42:2.0.1.2.9.2.35.8SECTION 409.17
   409.17 Physical therapy, occupational therapy, and speech-language pathology services.
42:2.0.1.2.9.2.35.9SECTION 409.18
   409.18 Services related to kidney transplantations.
42:2.0.1.2.9.3SUBPART C
Subpart C - Posthospital SNF Care
42:2.0.1.2.9.3.35.1SECTION 409.20
   409.20 Coverage of services.
42:2.0.1.2.9.3.35.2SECTION 409.21
   409.21 Nursing care.
42:2.0.1.2.9.3.35.3SECTION 409.22
   409.22 Bed and board.
42:2.0.1.2.9.3.35.4SECTION 409.23
   409.23 Physical therapy, occupational therapy, and speech-language pathology services.
42:2.0.1.2.9.3.35.5SECTION 409.24
   409.24 Medical social services.
42:2.0.1.2.9.3.35.6SECTION 409.25
   409.25 Drugs, biologicals, supplies, appliances, and equipment.
42:2.0.1.2.9.3.35.7SECTION 409.26
   409.26 Transfer agreement hospital services.
42:2.0.1.2.9.3.35.8SECTION 409.27
   409.27 Other services generally provided by (or under arrangements made by) SNFs.
42:2.0.1.2.9.4SUBPART D
Subpart D - Requirements for Coverage of Posthospital SNF Care
42:2.0.1.2.9.4.35.1SECTION 409.30
   409.30 Basic requirements.
42:2.0.1.2.9.4.35.2SECTION 409.31
   409.31 Level of care requirement.
42:2.0.1.2.9.4.35.3SECTION 409.32
   409.32 Criteria for skilled services and the need for skilled services.
42:2.0.1.2.9.4.35.4SECTION 409.33
   409.33 Examples of skilled nursing and rehabilitation services.
42:2.0.1.2.9.4.35.5SECTION 409.34
   409.34 Criteria for “daily basis”.
42:2.0.1.2.9.4.35.6SECTION 409.35
   409.35 Criteria for “practical matter”.
42:2.0.1.2.9.4.35.7SECTION 409.36
   409.36 Effect of discharge from posthospital SNF care.
42:2.0.1.2.9.5SUBPART E
Subpart E - Home Health Services Under Hospital Insurance
42:2.0.1.2.9.5.35.1SECTION 409.40
   409.40 Basis, purpose, and scope.
42:2.0.1.2.9.5.35.2SECTION 409.41
   409.41 Requirement for payment.
42:2.0.1.2.9.5.35.3SECTION 409.42
   409.42 Beneficiary qualifications for coverage of services.
42:2.0.1.2.9.5.35.4SECTION 409.43
   409.43 Plan of care requirements.
42:2.0.1.2.9.5.35.5SECTION 409.44
   409.44 Skilled services requirements.
42:2.0.1.2.9.5.35.6SECTION 409.45
   409.45 Dependent services requirements.
42:2.0.1.2.9.5.35.7SECTION 409.46
   409.46 Allowable administrative costs.
42:2.0.1.2.9.5.35.8SECTION 409.47
   409.47 Place of service requirements.
42:2.0.1.2.9.5.35.9SECTION 409.48
   409.48 Visits.
42:2.0.1.2.9.5.35.10SECTION 409.49
   409.49 Excluded services.
42:2.0.1.2.9.5.35.11SECTION 409.50
   409.50 Coinsurance for durable medical equipment (DME) and applicable disposable devices furnished as a home health service.
42:2.0.1.2.9.6SUBPART F
Subpart F - Scope of Hospital Insurance Benefits
42:2.0.1.2.9.6.35.1SECTION 409.60
   409.60 Benefit periods.
42:2.0.1.2.9.6.35.2SECTION 409.61
   409.61 General limitations on amount of benefits.
42:2.0.1.2.9.6.35.3SECTION 409.62
   409.62 Lifetime maximum on inpatient psychiatric care.
42:2.0.1.2.9.6.35.4SECTION 409.63
   409.63 Reduction of inpatient psychiatric benefit days available in the initial benefit period.
42:2.0.1.2.9.6.35.5SECTION 409.64
   409.64 Services that are counted toward allowable amounts.
42:2.0.1.2.9.6.35.6SECTION 409.65
   409.65 Lifetime reserve days.
42:2.0.1.2.9.6.35.7SECTION 409.66
   409.66 Revocation of election not to use lifetime reserve days.
42:2.0.1.2.9.6.35.8SECTION 409.68
   409.68 Guarantee of payment for inpatient hospital or inpatient CAH services furnished before notification of exhaustion of benefits.
42:2.0.1.2.9.7SUBPART G
Subpart G - Hospital Insurance Deductibles and Coinsurance
42:2.0.1.2.9.7.35.1SECTION 409.80
   409.80 Inpatient deductible and coinsurance: General provisions.
42:2.0.1.2.9.7.35.2SECTION 409.82
   409.82 Inpatient hospital deductible.
42:2.0.1.2.9.7.35.3SECTION 409.83
   409.83 Inpatient hospital coinsurance.
42:2.0.1.2.9.7.35.4SECTION 409.85
   409.85 Skilled nursing facility (SNF) care coinsurance.
42:2.0.1.2.9.7.35.5SECTION 409.87
   409.87 Blood deductible.
42:2.0.1.2.9.7.35.6SECTION 409.89
   409.89 Exemption of kidney donors from deductible and coinsurance requirements.
42:2.0.1.2.9.8SUBPART H
Subpart H - Payment of Hospital Insurance Benefits
42:2.0.1.2.9.8.35.1SECTION 409.100
   409.100 To whom payment is made.
42:2.0.1.2.9.8.35.2SECTION 409.102
   409.102 Amounts of payment.