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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

55 Pa. Code § 1151.2. Definitions.

§ 1151.2. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   Acute psychiatric services—Psychiatric services rendered in response to a severe psychiatric condition requiring intervention to bring the patient’s symptoms under control.

   Certified day—A day of inpatient hospital care approved by the Department under this chapter.

   Day of inpatient hospital care—Room, board and professional services furnished to a patient on a continuous 24-hour-a-day basis in a semiprivate room of a hospital. The term includes items and services ordinarily furnished by the hospital for the care and treatment of inpatients provided in an institution other than one maintained primarily for treatment and care of patients with tuberculosis.

   Emergency admission—The unscheduled admission of a person with a severe mental disability who requires immediate treatment, to an inpatient psychiatric facility.

   Fiscal year—A period of time beginning July 1 and ending June 30 of the following year.

   General hospital—A facility licensed as a hospital under 28 Pa. Code Part IV, Subpart A (relating to general and special hospitals) which provides equipment and services primarily for inpatient care to persons who require treatment for injury, illness, disability or pregnancy. The term does not include public or private psychiatric hospitals, general nursing facilities, county-operated nursing facilities, intermediate care facilities for the mentally retarded or psychiatric transitional facilities.

   Inpatient psychiatric facility—The term refers to private psychiatric hospitals and distinct part psychiatric units of general hospitals.

   Patient pay amount—Income or assets that the CAO has determined to be available to a recipient to meet the cost of medical care. The recipient, not the MA Program, pays this amount toward the cost of care.

   Private psychiatric hospital—An institution, other than a general hospital, not directly operated or controlled by the Department that is engaged in providing acute short-term psychiatric services on an inpatient basis.

   Public psychiatric hospital—An institution, other than a general hospital, controlled, operated and funded directly by the Department and engaged in providing long-term and short-term inpatient psychiatric services for the diagnosis, treatment and care of individuals with mental diseases.

   Recipient under 21 years of age—A recipient who is one of the following:

     (i)   Under 21 years of age.

     (ii)   Age 21 and was receiving inpatient psychiatric services in a psychiatric hospital the day preceding the date the recipient reached age 21. This recipient continues to be recognized as a recipient under 21 years of age until the earlier of the date the recipient either:

       (A)   No longer requires inpatient psychiatric facility services.

       (B)   Reaches age 22.

   Therapeutic leave—A period of absence by a patient from the inpatient psychiatric facility directly related to the treatment of that patient’s illness.


   The provisions of this §  1151.2 amended under sections 201(2), 403(b), 443.1, 443.3, 443.6, 448 and 454 of the Public Welfare Code (62 P. S. § §  201(2), 403(b), 443.1, 443.3, 443.6, 448 and 454).


   The provisions of this §  1151.2 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2976; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241; amended August 26, 2005, effective August 29, 2005, 35 Pa.B. 4811. Immediately preceding text appears at serial pages (259615) to (259616) and (293659).

Notes of Decisions

   Private Psychiatric Hospital

   The definition of ‘‘private psychiatric hospital’’ does not preclude a facility from providing other than acute short-term inpatient psychiatric care; rather, it must provide at least that type of services to qualify as a private psychiatric hospital. Devereux Hospital Texas Treatment Network v. Department of Public Welfare, 797 A.2d 1037 (Pa. Cmwlth. 2002), appeal granted, 827 A.2d 1202 (Pa. 2003) and affirmed in part, reversed in part, 855 A.2d 842 (Pa. 2004); remand 878 A.2d 967 (Pa. Cmwlth. 2005); appeal denied 918 A.2d 748 (Pa. 2007).

Cross References

   This section cited in 55 Pa. Code §  1151.21 (relating to scope of benefits for the categorically ready); and 55 Pa. Code §  1151.22 (relating to scope of benefits for the medically needy).

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