Title: Section 86-1.30 - Swing bed reimbursement

Effective Date

03/16/2011

86-1.30 Swing bed reimbursement. (a) Definitions. (1) For purposes of this section, eligible hospitals shall mean those hospitals defined as rural hospitals and meeting the swing bed program requirements in Part 406 of this Title.

(2) Rate shall mean the aggregate governmental payment made to eligible facilities per patient day as defined in section 86-2.8 of this Part for the care of patients receiving care pursuant to Title XIX of the federal Social Security Act (Medicaid).

(b) Rates of payment. Payments to eligible hospitals for patient days resulting from the usage of swing beds in caring for patients for whom it has been determined that inpatient hospital care is not medically necessary, but that skilled nursing or health related care is required, shall be determined as follows:

(1) The operating component of the rate shall consist of the following:

(i) a direct component which shall be equivalent to the 1988 statewide average direct case mix neutral cost per day for hospital-based residential health care facilities, after application of the Regional Direct Input Price Adjustment Factor (RDIPAF) as determined pursuant to Subpart 86-2 of this Part, trended to the appropriate rate year;

(ii) an indirect component which shall be equivalent to the 1988 statewide average indirect cost per day for hospital-based residential health care facilities, after application of the RDIPAF pursuant to Subpart 86-2 of this Part, trended to the appropriate rate year;

(iii) a non-comparable component which shall be equivalent to the 1988 statewide average non-comparable cost per day for hospital-based residential health care facilities, trended to the appropriate rate year.

(2) For general hospitals with more than 49 beds, the maximum number of days for which the operating component of the rate as defined in paragraph (1) of this subdivision shall be paid shall be equivalent to fifteen (15) percent of a hospital's total annual patient days for acute, exempt unit, and alternate level of care services, excluding swing bed days.

(3) The operating component of the rate as defined in paragraph (1) of this subdivision shall be paid for the first sixty (60) days per year during which a patient is receiving care as a participant in the swinged program. Any patient stay in excess of sixty (60) days per year shall be reimbursed at the prevailing average rate paid for the care of Alternate Level of ALC) patients pursuant to the provisions of Section 86-1.56 of this Subpart. The sixty-day period shall begin the first day on which the patient receives care as a participant in the swing bed program.

(4) A capital cost per diem shall be paid on the basis of budgeted capital costs allocated to the swing bed program, pursuant to the provisions of section 86-1.59 of this Subpart, divided by patient days associated with the swing bed program, reconciled to actual total capital expense.

(c) Payments from all other payors. Payments to eligible hospitals for care provided to patients under the swing bed program by any non-governmental payor shall be at a per diem rate as established by such eligible hospital.

Volume

VOLUME A-2 (Title 10)

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