Swing Bed Hospital Services (Nursing Facility Swing Beds)

Posted: December 14, 2022

Overview
A swing bed is a service that rural hospitals and critical access hospitals (CAHs) with a Medicare provider agreement provide that allows a patient to transition from acute care to skilled nursing facility (SNF) care without leaving the hospital. This allows a patient to continue receiving services in the hospital even though acute care is no longer required.

State law allows Minnesota Health Care Programs (MHCP) payments for swing bed services provided by a designated licensed hospital, if the hospital meets the following criteria:

· The hospital is the sole community provider, or is a public hospital owned by a government entity with 15 or fewer acute care beds

· The MHCP member requires skilled nursing care per Medicaid guidelines

· A nursing home bed is not available within 25 miles of the facility

· The member is transferred from an acute care hospital bed and acute care is no longer needed

· The member must receive a preadmission screening before placement as specified in the Preadmission Screening section of this manual section

· The requirements specified in Hospital Enrollment Criteria and Forms

Eligible Swing Bed Providers

To be eligible as an MHCP swing bed provider, a provider must complete the following:

· Receive Medicare certification as a Medicare swing bed provider. Medicare certification requires a survey by MDH. Certification information may be obtained from:

Minnesota Department of Health (MDH)
Facility and Providers Compliance Division
85 East 7th Place
P.O. Box 64900
St. Paul, MN 55164
651-215-8701

· Sign a Swing Bed Provider Agreement with DHS. Provider agreement information may be obtained from:

Minnesota Department of Human Services
Nursing Facilities Rates and Policy.
P.O. Box 64973
St. Paul, MN 55164-0973

Or email DHS.LTCpolicycenter@state.mn.us

Exceptions: Swing bed services may be billed by a hospital not enrolled in MHCP only in the case of a Qualified Medicare Beneficiary (QMB) receiving Medicare swing bed services. Coinsurance and deductible on QMB claims will be paid for the length of the Medicare-approved stay. MHCP also covers up to 10 days of nursing care provided to a patient in a swing bed if:

· The member’s physician certifies that the member has a terminal illness or condition that is likely to result in death within 30 days and moving the member would not be in the best interests of the member and the member's family.

· A nursing home bed is not available within 25 miles of the facility.

· An open bed is not available in any Medicare hospice program within 50 miles of the facility.

Eligible Swing Bed Members

To be eligible for swing bed payment, there must be documentation that the member requires a level of skilled nursing care consistent with admission to a nursing facility and no longer requires acute care hospital services. If the need for skilled nursing care cannot be documented, the services are not eligible for MHCP payment. A copy of the preadmission screening document must be attached to the claim.

Preadmission Screening for Swing Beds

All members seeking placement in a swing bed must be screened through Senior LinkAge or a county social worker either through a community screening or through a telephone screening before admittance to a swing bed under the policy described in the Preadmission Screening (PAS) section of this chapter. Exceptions to PAS in swing bed placement are:

· Members admitted from the community on a physician-certified emergency basis or members admitted on a county non-working day must be screened on the first county working day after admission.

· Members returning to a swing bed who entered an acute care facility from a swing bed.

· Members in a swing bed who are transferring to another swing bed in another facility.

· Members who have a contractual right to have their swing bed services paid for by the Veterans Administration.

· Members who are enrolled in the Ebenezer/Group Health Social HMO Project at the time of application to the swing bed.

Swing Bed Services Limitations

Under state law, payment for swing bed services for an MHCP member is limited to 40 days, unless the Commissioner of MDH grants an extension. Approval for services in excess of 40 days must be requested in writing from MDH at least 10 days before the end of the maximum 40-day stay. The extension approval must be attached to claims, which include service dates beyond the initial 40-day period. Eligible hospitals are allowed a total of 1,460 days of swing bed use per the state's fiscal year; (July 1 to June 30) provided that no more than 10 hospital beds are used as swing beds at any one time.

Ancillary Swing Bed Services

Routine care and services, similar to those provided in a nursing facility (NF), are included in the daily swing bed payment rate. All other covered services may be billed to MHCP. All ancillary services must be billed according to the respective guidelines for the service, as outlined in the appropriate chapters of this manual.

Billing for Swing Bed Services

Bill as follows:

· Bill room and board services in the 837I format using the hospital's NPI.

· Use the 281 bill type.

· The daily room and board payment rate for swing bed services is set by law as the statewide average payment rate of all MHCP nursing facilities' per diem. Contact DHS.LTCpolicycenter@state.mn.us for rate information.

· Only bill non-over-the-counter (OTC) DHS formulary pharmacy services outside the room and board per diem. Stock medications and OTC products are not separately reimbursable.

· Bill ancillary services for Medicare eligible people to Medicare. If the services are not covered by Medicare, MHCP may be billed (fee-for-service members only).

Legal References

Minnesota Statutes, 144.562, subdivisions 2 and 3 (Swing Bed Approval; Issuance of License Conditions)