HFS pays for care provided to eligible customers by a qualifying hospital. 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 customers 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.