Swing Bed

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MEDICAID SWING BED
PROGRAM JANUARY 2020
 

Applicable Rules:
Administrative Rules of Montana at ARM 37.40.401-421 pertain 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 in medical record documentation that supports 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 (MPQH).

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 (SLTCD) 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 2021 (1/1/21 –12/31/21)    $ 207.36     $209.60 (Direct Care Wage)
FY 2020 (1/1/20 –12/31/20)    $ 199.99     $204.30 (Direct Care Wage)

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 (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.

January 2014

Cover Sheet: January 2014 Ancillary Services Rev. 06/27/2017
TXT: January 2014 Ancillary Services Rev. 06/27/2017

PDF: January 2014 Ancillary Services Rev. 06/27/2017  
EXCEL January 2014 Ancillary Services Rev. 06/27/2017
TXT: January 2014 Ancillary Services Rev. 06/27/2017  

2021

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

01/10/2020  Co-Payment Assessed in Error for January 6, 2020

2019

2018

11/20/2018  Appropriate Billing Reminder
11/08/2018  Rate Updates Mass Adjustment
10/19/2018 Medicaid Fee Schedules
07/02/2018 Updated CLIA Claims Editing
06/04/2018 Coding Resources Change
04/04/2018  Updated Passport Eligible Populations & Reimbursement
02/26/2018  New Rendering Only Provider Enrollment Application

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 443-0320 or 1-800-219-7035. Questions regarding this correspondence can be directed to either Shaunda Hildebrand at (406) 444-4209 or Jill Sark at (406) 444-4544.