Part 406 - Rural Hospital Swing Bed Demonstration

Effective Date: 
Wednesday, April 25, 1990
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803

Section 406.1 - Definition

Section 406.1 Definition.

For purposes of this section, a swing bed program operated by a rural hospital that has an approval from the Health Care Financing Administration (HCFA) to provide posthospital skilled nursing facility (SNF) care, shall mean beds used interchangeably as either general hospital or nursing home beds with reimbursement based on the specific type of care provided so that use of beds in this manner provides small hospitals with greater flexibility in meeting fluctuating demands for inpatient general hospital and nursing home care.
 

Effective Date: 
Wednesday, July 22, 1992
Doc Status: 
Complete

Section 406.2 - Applicability

406.2 Applicability. (a) With the prior approval of the commissioner pursuant to Part 710 of this Title and upon certification by the Health Care Financing Administration (HCFA), general hospitals located in a rural area including all areas not delineated as urbanized areas by the U.S. Census Bureau and licensed, exclusive of bassinets for newborns, distinct part psychiatric and rehabilitation unit beds and beds in intensive care inpatient units, for fewer than 100 inpatient beds or for 100 or more inpatient beds but consistently utilizing and staffing fewer than 100 beds shall be permitted to participate in the swing bed demonstration program. Participation in the program shall be for a period of three years and in accordance with the requirements of this Part. The program shall be conducted so as to show the extent and effect of the program on the availability and effective and economical provision of long-term care services in rural areas.

(b) The swing bed program shall utilize inpatient facilities and available beds in a manner which assures the provision of services to patients in accord with their assessed needs and shall be subject to the following:

(1) the swing bed program shall provide care throughout the period such patients require the nursing home level of care and in accord with the program's utilization review plan and policies governing length of stay; and

(2) patients may be admitted to the swing bed program for respite care in accord with nursing home medical eligibility criteria for admission so as to provide temporary relief to primary care givers; and

(3) reimbursement for patients whose length of stay exceeds 60 days shall be in accordance with alternate level of care payments (ALC) as set forth by Section 86-1.56 of this Title.
 

Effective Date: 
Wednesday, July 22, 1992
Doc Status: 
Complete

Section 406.3 - Admission, patient assessment, planning and services

406.3 Admission, patient assessment, planning and services. (a) The hospital administration shall develop and implement policies and procedures governing admission from the hospital's acute care unit(s), other hospital acute care unit(s), and the community, patient assessment, patient length of stay, patient care planning, and the provision of 24-hour nursing services and other services for the swing bed program which include as a minimum but are not limited to the following:

(1) the completion of the Hospital and Community Patient Review Instrument (H/C-PRI) and SCREEN prior to admission, and the PRI and SCREEN for admission review and continued stay review purposes for patients otherwise eligible for nursing home admission and whose expected length of stay does not exceed 60 days in coordination with procedures for discharge planning;

(2) patient's rights including admission, transfer, and discharge rights as set forth in Part 415 of this Title;

(3) patient care services and management in accord with the requirements governing patient behavior and facility practices as set forth in Part 415 of this Title; and

(4) patient care and services in accord with a multidisciplinary assessment of needs.

(b) A written, individualized, comprehensive care plan based upon the patient's assessed needs shall be developed and implemented which includes but is not limited to:

(1) assistance and/or supervision, when required, with activities of daily living, such as toileting, feeding, ambulation, bathing including routine skin care, care of hair and nails, and oral hygiene;

(2) rehabilitation therapy services as the patient's needs indicate;

(3) dental services as the patient's needs indicate;

(4) social services as the patient's medically related social and emotional needs indicate; and,

(5) an activities program involving community, interpersonal and self-care functions appropriate and sufficient in scope to the needs and interests of each patient to sustain physical and psychosocial functioning.
 

Effective Date: 
Wednesday, July 22, 1992
Doc Status: 
Complete

Section 406.4 - Transfer and affiliation agreements

406.4 Transfer and affiliation agreements. The hospital administration shall implement requirements governing transfer and affiliation agreements as set forth in section 400.9 of this Subchapter. In accordance with such agreements and for hospitals with more than 49 beds when a nursing home notifies such hospital of available bed(s), the hospital shall transfer the swing bed patient to the RHCF within 5 weekdays (excluding weekends and holidays) of the availability date unless the patient's physician certifies that a transfer is not medically appropriate.
 

Effective Date: 
Wednesday, July 22, 1992
Doc Status: 
Complete

Section 406.5 - Discharge planning

406.5 Discharge planning. The hospital administration shall implement procedures governing discharge planning as set forth in Part 405 of this Title and as also required for participation in the Medicaid program in coordination with the hospital's utilization review plan and policies governing length of stay applicable to the swing bed program in order to ensure that each patient has a planned program of continuing care that meets his or her post-discharge needs.
 

Effective Date: 
Wednesday, April 25, 1990
Doc Status: 
Complete

Section 406.6 - Evaluation

406.6 Evaluation. The hospital administration shall develop and implement procedures which provide for at least an annual written evaluation of the swing bed program to include, as a minimum, a profile of the characteristics of the patients admitted to the program, the services and degree of services drawn upon most, occupancy, length of stay and use rate, patient need and disposition upon discharge. The evaluation shall also include such items as may be identified and set forth on forms provided by the department.
 

Effective Date: 
Wednesday, April 25, 1990
Doc Status: 
Complete