Skip to Main Content

Swing Bed Providers

The Social Security Act (the Act) permits certain small, rural hospitals to enter into a swing bed agreement, under which the hospital can use its beds, as needed, to provide either acute or SNF care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Medicare Part A (the hospital insurance program) covers post-hospital extended care services furnished in a swing bed hospital.

Under the Balanced Budget Act (BBA) of 1997, swing bed facilities must be incorporated into the skilled nursing facility (SNF) prospective payment system (PPS) by the end of a statutory transition period. This applies to short term hospitals, long term hospitals, and rehabilitation hospitals certified as swing bed hospitals. CAHs with swing beds are exempt from the SNF PPS under more recent legislation. To qualify for SNF-level services, a beneficiary is required to receive acute care as a hospital inpatient for a medically necessary stay of at least 3 consecutive calendar days. Effective with cost reporting periods beginning on or after July 1, 2002, swing bed hospitals will no longer be paid based on the current cost-related method, but rather on the basis of the SNF PPS.

The SNF PPS covers all costs (ancillary, routine, and capital) related to covered services furnished to beneficiaries under Medicare Part A. Like the PPS for inpatient hospital services, the SNF PPS excludes certain specified services, which are separately billable to Part B. The PPS relies on information from a resident assessment instrument to classify residents into one of 44 categories for payment purposes. Swing bed hospitals will be required to use a special two-page assessment form to meet this requirement.