Episode of Care (Health Care) Law and Legal Definition

Episode of care means the managed care provided by a health care facility or provider for a specific medical problem or condition or specific illness during a set time period. Episode of care can be given either for a short period or on a continuous basis or it may consist of a series of intervals marked by one or more brief separations from care.

Pursuant to 42 USCS § 1395cc-4(a)(2)(D) Episode of care means, with respect to an applicable condition and an applicable beneficiary, the period that includes:

(I) the 3 days prior to the admission of the applicable beneficiary to a hospital for the applicable condition;

(II) the length of stay of the applicable beneficiary in such hospital; and

(III) the 30 days following the discharge of the applicable beneficiary from such hospital.

(ii) Establishment of period by the secretary. The Secretary, as appropriate, may establish a period (other than the period described in clause (i)) for an episode of care under the pilot program.