Hospital Providers of Extended Care Services

10.3 - Hospital Providers of Extended Care Services (Rev. 228, Issued: 10-13-16, Effective: 10-18-16, Implementation: 10-18-16) 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 for furnishing post-hospital extended care services to Medicare beneficiaries. Such a hospital, known as a swing bed facility, can “swing” its beds between the hospital and SNF levels of care, on an as- needed basis, if it has obtained a swing bed approval from the Department of Health and Human Services. See Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, Section 30.3 (“Hospital Providers of Extended Care Services”) for a description of general rules applicable to SNF-level services furnished in hospital swing beds; also, see Pub. 100-04, Medicare Claims Processing Manual, chapter 6, sections 100ff regarding SNF PPS billing procedures for SNF-level services furnished in rural (non-CAH) swing-bed hospitals. When a hospital is providing extended care services, it will be treated as a SNF for purposes of applying coverage rules. This means that services provided in the swing bed are subject to the same Part A coverage, deductible, coinsurance and physician certification/recertification provisions that are applicable to SNF extended care services. The SNF coverage provisions are set forth in 42 CFR 409 Subpart D and are more fully explained in this chapter. A patient in a swing bed cannot simultaneously receive coverage for both SNF-level services under Part A and inpatient hospital ancillary services under Part B. Swing bed patients who no longer qualify for Part A coverage of SNF-level services under the Medicare program (due to exhaustion of Part A SNF benefits, dropping below a SNF level of care, etc.) revert to receipt of a hospital level of care in the swing bed (see the Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B,” §10). Thus, any further Medicare coverage in the swing bed would be for inpatient hospital ancillary services under Part B, notwithstanding a patient’s eligibility for Medicaid NF coverage. A dually-eligible patient who continues to receive a SNF level of care or who has dropped below the SNF level may nonetheless still qualify for Medicaid coverage of nursing facility (NF) services, if the hospital has a Medicaid swing bed agreement that has been approved by the State in which the facility is located. Such agreements permit Medicaid-participating rural hospitals to use their beds interchangeably to furnish both acute hospital care and NF care to Medicaid recipients, when no beds are available in area nursing facilities (see Pub. 45, State Medicaid Manual, chapter 4, section 4560).