Hospital Providers of Extended Care Services

30.3 - Hospital Providers of Extended Care Services (Rev.114, Issued: 03-16-18, Effective: 06-19-18, Implementation: 06-19-18) In order to address the shortage of rural SNF beds for Medicare patients, rural hospitals with fewer than 100 beds may be reimbursed under Medicare Part A for furnishing post hospital extended care services to Medicare beneficiaries if the hospital has obtained a swing bed approval from the Department of Health and Human Services. Such a hospital, known as a swing bed hospital, can "swing" its beds between hospital and SNF levels of care, on an as needed basis. In accordance with §1883 of the Act, rural hospitals with fewer than 100 beds must make application and request approval to be a swing bed hospital from the regional office. In order to obtain swing bed approval, the hospital must: • As noted above, be located in a rural area (i.e., located outside of an "urbanized area," as defined by the Census Bureau and based on the most recent census, see 42 CFR 482.58(a)(2)) and have fewer than 100 beds (excluding intensive care-type beds and newborn bassinets) • Have a Medicare provider agreement, as a hospital; • Be substantially in compliance with the SNF participation requirements identified in 42 CFR 482.58; (most other SNF participation requirements would be largely met by virtue of the facility's compliance with comparable hospital conditions); • Not have in effect a 24-hour nursing waiver granted under 42 CFR 488.54(c); and • Not have had a swing bed approval terminated within the 2 years previous to application for swing bed participation. However, the Department may grant swing bed approval, on a demonstration basis, with hospitals meeting all of the statutory requirements except bed size and geographic location. Prior to October 1, 1990, a swing-bed hospital could also furnish intermediate care facility (ICF) type services to non-Medicare patients. Effective with services furnished on or after October 1, 1990, the distinction between SNFs and ICFs for certifying a facility for the Medicaid program was eliminated. Thus, for purposes of the Medicaid program, facilities may no longer be certified as ICFs but instead may be certified only as nursing facilities (NFs) and can provide services as defined in §1919(a)(1) of the Act. Effective October 1, 1990, such services furnished by swing-bed hospitals to Medicaid and to other non-Medicare patients are referred to as NF-type services. See §10.3 of Pub. 100-02, Medicare Benefit Policy Manual, chapter 8, for additional information on Part A coverage of SNF-level swing-bed services as extended care services.