37.40.405    SWING-BED HOSPITALS, SPECIAL SERVICE REQUIREMENTS

(1) Before admitting a Medicaid recipient to a swing-bed, the swing-bed hospital must meet all of the following requirements:

(a) the hospital must obtain a preadmission screening to determine the level of care required by the patient's medical condition. Medicaid will not reimburse a provider for swing-bed hospital services provided to a Medicaid recipient admitted to a swing-bed unless the recipient meets the nursing facility level of care requirements specified in ARM 37.40.202 and 37.40.205. The swing-bed hospital must ensure that form DPHHS-SLTC-61, "screening notification", is completed by the department preadmission screening team to document the level of care determination.

(b) Except when a waiver is obtained under (4), the hospital must determine that no appropriate nursing facility bed is available to the Medicaid patient within a 25 mile radius of the swing-bed hospital. The hospital is required to maintain written documentation of inquiries to nursing facilities about the availability of a nursing facility bed and indicating that if a bed is not available, the hospital will provide swing-bed services to the patient. The swing-bed hospital is encouraged to enter into availability agreements with Medicaid-participating nursing facilities in its geographic region that require the nursing facility to notify the hospital of the availability of nursing facility beds and dates when beds will be available.

(i) For purposes of this rule, an "appropriate" nursing facility bed is a bed in a Medicaid-participating nursing facility which provides the level of care required by the recipient's medical condition.

(2) A Medicaid patient admitted to a swing-bed must be discharged to an appropriate nursing home bed within a 25 mile radius of the swing-bed hospital within 72 hours of an appropriate nursing home bed becoming available.

(3) The requirements of (1)(b) and (2) apply regardless of the 30-day notice requirement generally applicable to transfers and discharges under ARM 37.40.420(1). When an appropriate nursing facility bed is or becomes available, the provider must provide notice as required by ARM 37.40.420(5)(f) and must otherwise comply with the requirements of ARM 37.40.420(1) to the extent practicable in the time available before transfer to the nursing facility bed.

(4) A provider may request a waiver of the determination requirement of (1)(b) for an acute care patient of the swing-bed hospital or may request for a swing-bed patient a waiver of the transfer requirement of (2) when the recipient's attending physician verifies in writing that either the recipient's condition would be endangered by transfer to an appropriate nursing facility bed within a 25 mile radius of the swing-bed hospital or that the individual has a medical prognosis that his or her life expectancy is six months or less if the illness runs its normal course.

(a) The waiver request and physician's written verification must be submitted to the Department of Public Health and Human Services, Senior and Long Term Care Division, 2030 11th Avenue, P.O. Box 4210, Helena, MT 59640-4210. Waiver approvals granted by county offices will not be valid or effective for purposes of this rule.

(b) The waiver request and physician's written verification must be received by the nursing facility services bureau within five working days of admission to the swing-bed or within five days of availability of an appropriate nursing facility bed and the provider must obtain written approval from the Medicaid services bureau prior to billing for services provided after the date of admission to the swing-bed or the date of availability of an appropriate nursing facility bed.

(5) The department may retrospectively review the use of swing-bed services provided to Medicaid patients and may deny payments when it is determined that the requirements of this rule were not met.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA; NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1989 MAR p. 670, Eff. 5/26/89; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 489; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2009 MAR p. 2166, Eff. 1/1/10.