42 C.F.R. § 410.43 Partial hospitalization services: Conditions and exclusions.
Title 42 - Public Health
(a) Partial hospitalization services are services that— (1) Are reasonable and necessary for the diagnosis or active treatment of the individual's condition; (2) Are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization; and (3) Include any of the following: (i) Individual and group therapy with physicians or psychologists or other mental health professionals to the extent authorized under State law. (ii) Occupational therapy requiring the skills of a qualified occupational therapist. (iii) Services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients. (iv) Drugs and biologicals furnished for therapeutic purposes, subject to the limitations specified in §410.29. (v) Individualized activity therapies that are not primarily recreational or diversionary. (vi) Family counseling, the primary purpose of which is treatment of the individual's condition. (vii) Patient training and education, to the extent the training and educational activities are closely and clearly related to the individual's care and treatment. (viii) Diagnostic services. (b) The following services are separately covered and not paid as partial hospitalization services: (1) Physician services that meet the requirements of §415.102(a) of this chapter for payment on a fee schedule basis. (2) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act. (3) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act. (4) Qualified psychologist services, as defined in section 1861(ii) of the Act. (5) Services furnished to SNF residents as defined in §411.15(p) of this chapter. [59 FR 6577, Feb. 11, 1994, as amended at 65 FR 18536, Apr. 7, 2000]
Title 42: Public Health
PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
Subpart B—Medical and Other Health Services
§ 410.43 Partial hospitalization services: Conditions and exclusions.
