February 13, 2012 | | Comments 0
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CMS posts revised fact sheet on swing bed services

As part of its Rural Health Fact Sheet Series, CMS recently issued a revised fact sheet on swing bed services.  Hospitals or critical access hospitals (CAH) that have received approval from CMS to provide swing bed services may, as needed, use their beds to provide either acute or skilled nursing facility (SNF) level care.  This flexibility promotes delivery of the most appropriate level of care to rural patients.  Under the swing bed provisions, hospitals and CAHs may use any acute bed (except beds in distinct part rehabilitation or psychiatric units, intensive care units, or nursery beds) for SNF level care.

Prior acute stay

In order for swing bed SNF services to be covered, the patient must be admitted as an inpatient to a hospital or CAH for at least three consecutive days prior to the swing bed admission.  In addition, the inpatient stay must have been covered by Medicare and must have occurred within 30 days prior to the swing bed admission.

Requirements

In order to be able to provide post-acute SNF level care, hospitals must meet the following requirements:

  • Be located in a rural area
  • Have fewer than 100 beds (excluding those for newborns and intensive care)
  • Have entered into a Medicare hospital participation agreement
  • Have not had a swing bed agreement with Medicare terminated within the prior two years
  • Not have a nursing waiver granted under 42 CFR 488.54(c);
  • Be substantially in compliance with the following SNF requirements set out in 42 CFR 482.66(b)(1-8):
    • Residents’ rights
    • Admission, transfer, and discharge rights
    • Resident behavior and facility practices
    • Patient activities
    • Social services
    • Discharge planning
    • Specialized rehabilitative services
    • Dental services

In order to be able to provide postacute SNF level care, CAHs must meet the following requirements:

  • Satisfy all of the specific Medicare prerequisites that generally apply to CAHs, including a 25-inpatient-bed limitation (excluding beds included in distinct part rehabilitation or psychiatric units, if any).  CAHs with approval from Medicare to provide swing bed services may use any of their regular 25 inpatient beds for either acute or SNF services.  (CAHs are also permitted to have up to 10 additional beds each in a rehabilitation and/or psychiatric distinct part unit.  However, beds in distinct part units may not be used for swing bed SNF services;)
  • Be substantially in compliance with the following SNF requirements set out in 42 CFR 482.645(d)(1-9):
    • Residents’ rights
    • Admission, transfer, and discharge rights
    • Resident behavior and facility practices
    • Patient activities (with exceptions for director of services)
    • Social services
    • Comprehensive assessment, comprehensive care plan, and discharge planning (with some exceptions)
    • Specialized rehabilitative services
    • Dental services
    • Nutrition

Payment

Hospitals (excluding CAHs) receive payment for swing bed SNF services under the SNF prospective payment system (PPS).  The SNF PPS payment includes payment for all covered Part A SNF services except for a limited number of specific services that are separately billable under Part B.  CAHs, on the other hand, are paid for their swing bed SNF services based upon 101% of the reasonable costs for those services.

In the fact sheet, CMS noted several additional resources, including the following website: http://www.cms.gov/SNFPPS/03_SwingBed.asp.  Chapter 8 of the Medicare Benefit Policy Manual and Chapter 6 of the Medicare Claims Policy Manual are also excellent sources of information on swing bed services:  http://www.cms.gov/Manuals/IOM/list.asp

Entry Information

Filed Under: Compliance

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Judith Kares About the Author: Judith Kares is an instructor for HCPro's Medicare Boot Camp - Hospital Version. Judith has also been involved in the following:

  • Development of comprehensive compliance programs
  • Initial and follow-up risk assessments
  • Development and implementation of compliance training programs
  • Compliance audits and internal investigations
  • Research/advice regarding specific risk areas
  • Development of corrective action programs
Prior to beginning her current legal/consulting practice, Judith spent a number of years in private law practice, representing hospitals and other health care clients, and then as in-house legal counsel. In that capacity, she served first as Assistant General Counsel and Director of the Legal Department for Blue Cross and Blue Shield of Arizona (BCBSAZ) and then as Deputy General Counsel, Regulatory and Contract Compliance, with Blue Cross and Blue Shield of the National Capital Area (BCBSNCA) in Washington, D.C.

In both in-house positions, Judith had primary responsibility for contracting and regulatory compliance. The latter included oversight of federal and state health care programs. BCBSAZ was a fiscal intermediary, a Medicare risk and AHCCCS (Arizona's managed care alternative to traditional Medicaid) contractor, as well as a participating contractor under the national Blue Cross/Blue Shield Federal Employee Program.

Judith is also an adjunct faculty member at the University of Phoenix, where she teaches courses in business and health care law and ethics. She is an advocate for the use of alternatives to traditional dispute resolution, having participated in the volunteer mediation program in the Justice Courts of Maricopa County, Arizona. Judith is a frequent speaker at healthcare-related seminars. In addition to her membership in the State Bar of Arizona and the Tennessee Bar Association, Judith is a member of the American Health Lawyers Association, the Health Care Compliance Association, and the Arizona Association of Health Care Lawyers.

Judith earned her Juris Doctor degree (with high distinction) from The University of Iowa, College of Law and her B.A. (with highest distinction) from Purdue University.

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