Both federal and state law allow certain small rural hospitals to enter into a swing bed agreement. This agreement essentially allows a hospital to use its beds to provide post-hospital skilled nursing facility (SNF) care to a patient (while retaining their ability to utilize the bed as a traditional hospital acute-care bed, hence the term “swing bed”).
Swing Beds – Definition
As defined in federal regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has approval from the Centers for Medicare and Medicaid Services (CMS) to provide post-hospital SNF care and meets certain requirements. These requirements are defined under 42 CFR 482.58 or 485.645, respectively (for hospitals or critical access hospitals).
Swing Beds – Medicaid Enrollment
Medicaid-certified hospitals interested in enrolling as Swing Bed providers should email the Department, to first determine their eligibility. Each hospital provider making such a request will be assessed to see if they meet existing requirements for Medicaid Swing Bed providers. The hospital provider will be notified of the outcome. If a provider is determined to meet all the swing bed requirements, swing bed rates will be entered into the MMIS system on their behalf.
Providers must meet all of the following swing bed criteria, namely the provider must:
- be licensed as a hospital (with Medicare swing bed license condition) in Minnesota,
- be a Medicare-certified hospital or critical access hospital (CAH) and be in compliance with the federal Medicare conditions of participation and the federal requirements for hospital providers of long-term care services,
- enroll as a Medicaid provider in Minnesota,
- sign a Medicaid swing bed provider agreement, and
- be eligible as a sole community provider (as defined under federal law) or is a public hospital owned by a government entity with 15 or fewer licensed acute care beds. Note: the sole community provider requirement is waived if the hospital was a Medicaid swing bed provider as of 1/1/2004.
In addition, to bill for Medicaid for swing bed services, the provider must show that:
- the patient no longer requires acute care services,
- has received the required screenings as provided by law, and
- no nursing facility beds are available within 25 miles of the facility.
Medicaid will provide up to 10 days of swing bed coverage for a patient if all the following conditions are met:
- the patient’s physician certifies that the patient has a terminal illness or condition that is likely to result in death within 30 days and that moving the patient would not be in the best interests of the patient and patient’s family,
- no open nursing facility beds are available within 25 miles of the facility, and
- no open beds are available in any Medicare hospice program within 50 miles of the facility.
Rates
Medicaid swing bed providers are paid the statewide weighted average per diem rate for all Medicaid residents residing in swing beds in the facility. This rate is determined by the Department.
For providers that meet the eligibility requirements, the Medicaid swing bed rate is uploaded to the provider’s rate file.
Notes
Please note that Swing Bed status for Medicare purposes is a separate issue and is determined completely separately from Medicaid. A provider’s Medicare swing bed status does not confer nor guarantee Medicaid swing bed eligibility.
Questions
If there are questions, please contact our department:
Munna Yasiri
Compliance and Intergovernmental Relations Director
Nursing Facility Rates & Policy Division
munna.yasiri@state.mn.us
