Wellcare CalViva Health Dual Align (HMO D-SNP): Inpatient Services in a Psychiatric Hospital
Inpatient psychiatric care can be provided in a psychiatric hospital or within a general hospital, under voluntary or involuntary admission.
How To Receive
Details on how to apply
Search the network for psychiatric hospitals and other mental health providers.
For Medicare-covered admissions, per admission: $0 copay for each mental health care stay
Covered services include mental health care services that require a hospital stay. You are covered for 90 days per admission for Medicare-covered stays. There is a 190-day lifetime limit for inpatient mental health services provided in a psychiatric hospital. The 190-day limit does not apply to inpatient mental health services provided in a psychiatric unit of a general hospital. If you have used part of the 190-day Medicare lifetime benefit prior to enrolling in our plan, then you are only entitled to receive the remainder of your lifetime days.
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When someone is in a mental crisis, admission into a psychiatric hospital may be necessary. A person may voluntarily admit themselves to a psychiatric hospital, or they may be involuntarily admitted to the hospital in the event that they are determined by a psychiatrist and a judge to be a danger to themselves or others, or are gravely disabled, and either knowingly deny admission or are unable to consent to admission. Examples of crises include suicidal or homicidal ideation, uncontrolled symptoms and behaviors associated with post-traumatic stress disorder, aggressive dementia-associated behaviors, and psychosis associated with mental or mood disorders, among others.
The plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The 190-day lifetime limit does not apply to inpatient mental health services provided in a psychiatric unit of a general hospital.
The plan also covers 60 lifetime reserve days. These are "extra" days that the plan covers. If the hospital stay is longer than 90 days, these extra days can be used. But once these extra 60 days have been exhausted, going forward, inpatient hospital coverage will be limited to only the 90 days per benefit period.
*Note that psychiatric care provided within a general hospital, on a locked unit, designated for psychiatric care, is considered the same as psychiatric hospital care. Inpatient mental health services furnished in a general hospital means that the individual is admitted to a general hospital unit (not a psychiatric unit) for another condition, yet also receiving psychiatric services. The former counts toward the 190-day lifetime limit, the latter does not.
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