Swing Bed

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Medicaid Swing Bed Program January 2022

Applicable Rules

Administrative Rules of Montana at 37.40.401-421 pertains to the Medicaid requirements and payments for services in swing bed hospitals.

Participation Requirements

  • Be a licensed hospital, licensed medical assistance facility (MAF), or critical access hospital (CAH), which is Medicare certified to provide swing bed services.
  • Enroll as a Medicaid swing bed hospital provider.
  • Have fewer than 50 hospital beds, excluding beds for newborn and intensive care, beds in a distinct part psychiatric or rehabilitation unit, beds in a separately certified nursing facility, and beds that are not consistently utilized by the hospital.
  • Be located in a rural area of the state.

Admission Requirements

  • Swing beds are to be used only when there is no appropriate nursing facility bed available within a 25-mile radius of the swing bed hospital or critical access hospital that can meet the member’s needs.
  • Swing bed hospitals and critical access hospitals must canvas all the nursing facilities within the 25-mile radius to determine the availability of an appropriate nursing facility bed prior to admission of the member to the swing bed.
  • Swing bed hospital and critical access hospital must include medical record documentation supporting that no nursing facility bed was available in order to document the appropriateness of the admission into the swing bed and the billing to Medicaid.
  • Medicaid member must meet level of care requirements based on screening completed by the Mountain-Pacific Quality Health.

Transfer Requirements

Medicaid member must be discharged to an appropriate nursing facility bed within the 25-mile radius of the swing bed hospital/critical access hospital when such bed becomes available.

Waiver of Transfer

Physician may request in writing a waiver of the 25-mile transfer requirement if:

  • The member’s condition would be endangered by the transfer to an appropriate nursing facility bed; or
  • The member has a medical prognosis or terminal condition whereby his/her life expectancy is six months or less.

Senior and Long-Term Care Division evaluates this information and will either approve or deny this request for a waiver in writing to the swing bed hospital.

Medicaid Reimbursement Rate

Medicaid swing bed hospital per diem rate is the statewide average Medicaid per diem rate paid to all nursing facilities for routine services for the previous calendar year. Rates are computed annually and are the same for each swing bed provider:

FY 2022 (1/1/22 -12/31/22) $211.62
FY 2021 (1/1/21 -12/31/21) $207.36 $209.60 (Direct Care Wage**)

** The nursing facility rate methodology changed July 1, 2020. The new methodology no longer includes the direct care wage that was included in the rate from 2009. Therefore, the direct care wage has also been eliminated from the swing bed rate.

Billing

Swing bed providers bill the per diem rate established by Medicaid on the Form MA-3. Beginning March 4, 2010, swing bed facilities may now bill Montana Medicaid electronically for per diem charges. Services that are included in the swing bed per diem rate and the services that can be billed in addition to the per diem are the same as for nursing facility providers.

Providers

There are currently 46 Montana facilities enrolled in the Medicaid swing bed program.

Contacts

For reimbursement rates, contact Dee Burnham at (406) 444-4129.
For waivers of the transfer requirements, contact Jenifer Thompson at (406) 444-3997.

General Information for Providers  
Medicaid manual with general information for all provider types.

Nursing Facility and Swing Bed Services 10/2017
This manual has information specific to your provider type.

2024

03/27/2024 HHS Letter to Healthcare Providers
03/27/2024 Resources for Providers in Response to the Change Healthcare Cyberattack
03/27/2024 Updated CLIA Claims Editing
03/27/2024 Avoiding Claim Denials
03/27/2024 Location Address and Provider Maintenance Updates
03/19/2024 Electronic Funds Transfer Payment Verification
03/12/2024 Valid Member ID and Eligibility Verification
03/12/2024 Provider Initiated Claims Adjustment
03/05/2024 Voiding Claims With a Prior Authorization
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/08/2024 Electronic Claim Adjustment Processing Change  

2023

12/22/2023 Passport Provider Referral Number on Claims
12/12/2023 Individual Providers Enrolled as Sole Proprietors Due for Revalidation
11/08/2023 Prior Authorization Information
10/31/2023 Managed Care Referrals IHS, Tribal 638, and Urban Indian Organizations REVISED
10/30/2023 Medicaid Nursing Facility Reimbursement and Patient Contribution
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/28/2023 Wheelchair and Bariatric Equipment Coverage for Nursing Facility Residents
06/28/2023 Nursing Facility QMB Claims
05/30/2023 Add-Ons Moving to Mountain-Pacific Quality Health
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
04/10/2023 Resumption of Face-to-Face Requirements for Selected Programs REVISED

03/22/2023 Coverage and Reimbursement Policy for Telemedicine/Telehealth Services
03/22/2023 End of Public Health Emergency (PHE) Effects on Pharmacy Coverage
03/22/2023 Non-Covered Services Agreement Policy Return to Requirements
03/22/2023 Reinstatement of the Primary Care Provider Referral for Passport
03/22/2023 Resumption of Face-to-Face Requirements for Selected Programs
03/22/2023 Resumption of Prior Authorization Requirements Revised 04/03/2023
03/17/2023 End of Temporary Revision to Case Management General Provisions
03/10/2023 Provider Meetings for Medicaid Eligibility Redetermination and Unwinding PHE Flexibilities
03/09/2023 Add-on and E&M Code Editing
03/03/2023 End of Public Health Emergency
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures

2022

12/30/2022 Medicaid Nursing Facility Reimbursement and Patient Contribution
08/05/2022 Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes
05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered
05/13/2022 Revalidation Extended REVISED
05/13/2022 National Drug Code (NDC) Denial Errors
04/26/2022 Health Behavior Assessment and Intervention Billing Codes REVISED
03/29/2022 Nurse First Advice Line Services Ending
03/16/2022 Revalidation Extended to June 2022 REVISED Rev. 05/13/2022
02/23/2022 Revalidation Extended to June 2022 Rev. 03/16/2022
02/23/2022 Standing Orders and Medicaid Reimbursement
01/14/2022 Montana Healthcare Programs Support Services Holiday Closures

2021

12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/10/2021 New Provider Services Portal
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
06/11/2021  COVID-19 Vaccine Administration Billing Guidance 
05/17/2021  Process to Enter PASRR requests through the Qualitrac portal
04/02/2021 
New Provider Type – Licensed Marriage and Family Therapist
01/28/2021  Montana Healthcare Programs Support Services Holiday Closures
01/11/2021  Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021

2020

12/07/2020  Medicaid Expansion Extended Through December 31, 2021 
10/28/2020  Provider Relief Fund General Allocation
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020

07/24/2020 Provider Relief Fund General Allocation

7/17/2020  Medicaid Reimbursement and Court Ordered Services
06/17/2020  National Correct Coding Initiative Announcement
05/15/2020  Temporary Revision to Case Management General Provisions
04/30/2020  National Correct Coding Initiative Announcement
04/28/2020  Temporary Suspension of the PCP Referral Requirement
04/27/2020  Non-Covered Services Agreement Policy Change

04/22/2020  Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs


04/01/2020  Suspension of Face to Face Requirements for Some Medicaid Programs
03/19/2020  Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth  rev 03/27/2020

Level of Care Screens (LOC) for Nursing Facility Residents
Level of care screening must be completed for Medicaid patients in order to receive Medicaid payments for nursing facility stays.  The level of care screening must be requested prior to admission or Medicaid coverage as they may only be backdated 30 days if the individual meets level of care and has completed a Level I screen. Please review the information below regarding level of care.

Please review the following:

LOC Level of Care Screening Information
LOC Cover letter
LOC Flow Chart
LOC Determination form

If you have any questions about LOC(s), please contact Mountain Pacific Quality Health at (406) 443-0320 or (800) 219-7035. Questions can also be directed to the Community Services Bureau at (406) 444-4077.