SNF Prospective Payment System
Swing Bed Providers -- Summary
| SNF PPS Swing Bed Highlights |
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The Social Security Act (the Act) permits certain small, rural
hospitals to enter into a swing bed agreement, under which the
hospital can use its beds, as needed, to provide either acute or SNF
care. As defined in the regulations, a swing bed hospital is a
hospital or critical access hospital (CAH) participating in Medicare
that has CMS approval to provide post-hospital SNF care and meets
certain requirements. Medicare Part A (the hospital insurance program)
covers post-hospital extended care services furnished in a swing bed
hospital.
Under the Balanced Budget Act (BBA) of 1997, swing bed facilities
must be incorporated into the skilled nursing facility (SNF)
prospective payment system (PPS) by the end of a statutory transition
period. This applies to short term hospitals, long term hospitals, and
rehabilitation hospitals certified as swing bed hospitals. CAHs with
swing beds are exempt from the SNF PPS under more recent legislation.
To qualify for SNF-level services, a beneficiary is required to
receive acute care as a hospital inpatient for a medically necessary
stay of at least 3 consecutive calendar days. Effective with cost
reporting periods beginning on or after July 1, 2002, swing bed
hospitals will no longer be paid based on the current cost-related
method, but rather on the basis of the SNF PPS.
The SNF PPS covers all costs (ancillary, routine, and capital)
related to covered services furnished to beneficiaries under Medicare
Part A. Like the PPS for inpatient hospital services, the SNF PPS
excludes certain specified services, which are separately billable to
Part B. The PPS relies on information from a resident assessment
instrument to classify residents into one of 44 categories for payment
purposes. Swing bed hospitals will be required to use a special
two-page assessment form to meet this requirement.
- Information for Swing Bed Hospitals in the Process of Converting to Critical Access Hospitals (CAHs)
- Rural Hospitals with Swing Beds
