Definition, Authority and Requirements for Hospital Providers of

2036 - Definition, Authority and Requirements for Hospital Providers of Extended Care Services (“Swing-Beds”) (Rev. 1, 05-21-04) “Swing-bed” is a reimbursement term that means the care and reimbursement for the care of a patient in a small rural hospital or CAH “swings” from acute care to post hospital skilled nursing care (SNF). A swing-bed hospital means a hospital or CAH participating in Medicare that has an approval from CMS to provide post hospital SNF care and meets the requirements specified in §482.66 for a hospital or §485.645 for a CAH. Certification to provide swing-beds is an approval separate from the certification to operate as a hospital or CAH. When a survey of swing-beds is completed, any deficiencies and Plans of Correction (PoC) must be documented on a separate Form CMS-2567. If the swing-beds are voluntary terminated or terminated by CMS, that action does not affect the continuing operation of the provider as a hospital or CAH. It terminates the approval to operate and receive reimbursement for the swing-beds. The swing-beds in a hospital or CAH do not have to be separated from the acute patients although the facility may choose to do so. The patients do not have to move to a different location in the facility when changing from acute care status to swing-bed status unless the facility requires it. There is no length of stay restriction for a swing-bed patient whether they are in a hospital or a CAH. There is no required discharge to a nursing home and no transfer agreement. Patients may be discharged to a nursing home as part of discharge planning, but it is not required. A medical order in the chart by the physician is required to change status from acute care to swing-bed because the patient is being discharge from acute care status and admitted to swing-bed status. This is necessary for reimbursement purposes because the billing and reimbursement change or “swing.” Accordingly, the facility is given a subprovider number for billing swing-bed services. For Medicare patients, a 3-day qualifying stay in any hospital or CAH is required to prior to admission to a swing-bed and the admission must be for treatment of the same condition. This 3-day qualifying stay only applies to a Medicare patient. Section 1883 of the Act authorizes payment under Medicare for post-hospital SNF services provided by any hospital that meets the following requirements at 42 CFR 482.66. These requirements include the following. ● The hospital has a Medicare provider agreement; ● The facility has fewer than 100 hospital beds, excluding beds for newborns and beds in intensive care type inpatient units; ● The hospital is located in a rural area. This includes all areas not delineated as “urbanized” areas by the Census Bureau, based on the most recent census; ● The hospital does not have in effect a 24-hour nursing waiver granted under 42 CFR 488.54(c); ● The hospital has not had a swing-bed approval terminated within the two years previous to application; ● The hospital meets the Swing-bed CoPs (see 42 CFR 482.66) on Resident Rights; Admission, Transfer, and Discharge Rights; Resident Behavior and Facility Practices; Patient Activities; Social Services; Discharge Planning; Specialized Rehabilitative Services; and Dental Services. NOTE: The 30-day patient transfer notice requirement at 42 CFR Part 483.12(a)(5) does not apply to swing-bed hospitals.