(a) To be a covered benefit under medical assistance for the needy as provided in section 365-a(2)(b) of the Social Services Law, any hospital stay beyond 20 days per spell of illness, except for rehabilitation care as hereinafter provided, during which all or any part of the cost of such care, services and supplies are claimed as items of medical assistance shall require a prior determination of coverability by a person designated by the Commissioner of Health. Any hospital stay for care under an established plan for rehabilitation of physical disability in a rehabilitation hospital or rehabilitation unit, beyond 40 days shall require such prior determination of coverability. A written request for such determination shall be made by the patient's physician. Such request shall include evidence documented in the patient's medical record showing that in order to preserve life or to prevent substantial risk of continuing disability, an additional period of care is required of such complexity or intensity that it can be provided only in a hospital. Care of such complexity or intensity shall include, but not be limited to:

1. (1) severe burns requiring continued therapy in a burns unit.
2. (2) continuing cardiovascular, renal or pulmonary decompensation requiring care in a coronary care unit, intensive care unit, pulmonary care unit or other acute care setting in the hospital.
3. (3) central nervous system damage with threatened or impaired consciousness.
4. (4) persistent fever or serious infection.
5. (5) persistent hemorrhage or threat of recurrent hemorrhage.
6. (6) life threatening conditions including malignancy when chemotherapy, radiotherapy or other therapy can be provided and monitored effectively only in a hospital.
7. (7) conditions requiring physical rehabilitation under an established rehabilitation plan when such treatment can be carried out only in a hospital setting.