WAG 20-06-00.

HFS pays for care provided to eligible clients by a qualifying hospital. GA-FCA adults and children and Category P3 TA clients are eligible for hospital services. Category 07 TA clients are not eligible for hospital services. Hospital care can be either inpatient or outpatient.

Inpatient care is for patients admitted to the hospital. The length of a hospital stay is controlled by the hospital's Utilization Review (UR) Committee. HFS has a contract with a Peer Review Organization to spot-check a sample of hospital stays to verify that the stays are not longer than is medically necessary. Medicare has a similar contract to review lengths of stay for clients receiving Medicare benefits.

There are 2 types of outpatient services:

  • emergency services in an emergency room for the relief of severe pain or the immediate diagnosis or treatment of a condition that could result in disability or death; or
  • hospital outpatient services, such as outpatient surgery.

Some hospitals also provide non-hospital services, such as physician, clinic, or in-home renal dialysis services.