SWING BED ELIGIBILITY. To be eligible to receive a Medicaid payment under this
rule, a hospital must:
(a) Have approval from
the Centers for Medicare and Medicaid Services (CMS) to furnish skilled nursing
facility services as a Medicare swing-bed hospital;
(b) Have a Medicare provider agreement for
acute care; and
(c) Have a current
signed provider agreement with SPD to receive Medicaid payment for swing-bed
(a) A critical access hospital (CAH)
not located within a 30 mile geographic radius of a licensed nursing facility
as of March 13, 2007 may receive Medicaid payment for up to 20 residents at one
time. The CAH must maintain at least five beds or twice the average acute care
daily census, whichever is greater, for exclusive acute care use.
Other hospitals receiving payment for
Medicaid services under this rule may not receive Medicaid payment for more
than a total of five residents at one time. In addition, the residents must
have a documented need for and receive services that meet the complex medical
add-on requirements outlined in OAR 411-070-0091
(c) If circumstances change so that a CAH
receiving payment for Medicaid services pursuant to section (2)(b) of this rule
meets the criteria set out in section (2)(a) of this rule after March 13, 2007,
the CAH may petition SPD for authorization to receive such payment pursuant to
section (2)(a) of this rule. SPD shall evaluate all available long-term care
resources within a 30 mile geographic radius of the CAH and the amount of unmet
long-term care need in the same area and determine if the CAH shall be
authorized to receive payment pursuant to section (2)(a) of this
PROVIDED. The daily Medicaid rate shall be for the services outlined in OAR
COMPLIANCE WITH MEDICAID REQUIREMENTS. Hospitals receiving Medicaid payment for
swing-bed services must comply with federal and SPD rules and statutes that
affect long-term care facilities as outlined in the facility's provider
agreement with SPD.
OF INDIVIDUALS. Prior to determination of Medicaid payment eligibility in the
swing bed, the case manager must determine there is no nursing facility bed
available to the individual within a 30 mile geographic radius of the hospital.
For the purpose of this rule, "available bed" means a bed in a nursing facility
that is available to the individual at the time the placement decision is
Or. Admin. R.
SSD 7-1988, f. & ef.
7-1-88; SSD 20-1990, f. & cert. ef. 10-4-90; SSD 6-1993, f. 6-30-93, cert.
ef. 7-1-93; SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97; SPD 9-2006, f. 1-26-06,
cert. ef. 2-1-06; SPD 1-2007, f. 3-12-07. & cert. ef. 3-13-07; SPD 15-2009,
f. 11-30-09, cert. ef. 12-1-09
Stat. Auth.: ORS
Stats. Implemented: ORS