COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to NH Placement

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS issued SE20018 on May 20, 2020.  This MLN Matters Article “is for hospitals requesting Medicare approve swing beds as a hospital service to provide skilled nursing level care for hospitalized patients who don’t need acute level care but can’t find nursing home placement during the COVID-19 Public Health Emergency (PHE).”

The 8-page MLN Matters “provides answers to the key questions hospitals may have as they pursue this option for treating their patients.”  Those questions are:

  • What is a swing bed and how is it relevant to hospitals?
  • Can any hospital have swing beds?
  • How do hospitals request approval for swing beds?
  • Do hospitals have to designate a special unit in the hospital for swing beds?
  • Under the current PHE, can a hospital make other arrangements besides applying for swing bed approval for a SNF to admit the hospital’s SNF-level patients and care for them in the hospital’s beds?
  • My hospital has patients ready for discharge to a SNF. We have been unable to find a SNF to accept some of our patients for post-acute care. We have not yet pursued a swing bed approval nor have we located a SNF to facilitate an arrangement. Can we receive outlier or other special payments under IPPS or OPPS for keeping the patient additional days?
  • Who does the swing bed waiver apply to?
  • How do hospitals request approval for swing beds?
  • How can rural or urban hospitals qualify for the waiver?
  • My hospital is currently allowed to have swing beds under Medicare policy. Can my hospital increase the number of swing beds under this waiver? If so, how?
  • Do hospitals exercising the SNF swing bed waiver need to complete an MDS Swing Bed Assessment to be paid under the SNF PPS?
  • Is there a tool to help hospitals access the MDS Swing Bed Assessment?
  • What resources are available to hospitals for questions about completing the MDS?
  • How do hospitals bill for patients located in a swing bed receiving a SNF Level of Care?
  • How is the SNF PPS payment rate determined?
  • Where can hospitals find information on the SNF PPS PDPM?
  • What are the SNF provisions set out at 42 CFR 482.58(b)?