37.40.402    SWING-BED HOSPITALS, PROVIDER PARTICIPATION REQUIREMENTS

(1) To participate and be reimbursed as a swing-bed hospital service provider in the Montana medicaid program, a hospital must meet all of the following requirements:

(a) The hospital is a swing-bed hospital as defined in ARM 37.40.401.

(b) The hospital has fewer than 50 hospital beds and has provided written assurance to the health care financing administration that the hospital will not operate over 49 hospital beds, including swing-beds, except in connection with a catastrophic event.

(i) The hospital bed count is determined by excluding from the total licensed hospital beds:

(A) beds which because of their special nature would not be available for swing-bed use, such as newborn and intensive care beds;

(B) beds included in a separately certified skilled nursing facility or nursing facility;

(C) beds included in a distinct part psychiatric or rehabilitation unit; and

(D) beds which the department determines are not consistently staffed and utilized by the hospital, as demonstrated by the hospital's staffing schedules and census records for the 12 months immediately preceding application for enrollment as a medicaid swing-bed hospital services provider.

(c) The critical access hospital (CAH) with swing-bed approval has no more than 25 acute care inpatient beds, of which no more than 15 are used for acute care at any one time for providing inpatient care.

(d) The hospital is located in a rural area of the state. A rural area is an area which is not designated as "urbanized" by the most recent official census. A copy of the bureau of the census listing of urbanized areas is available upon request from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(e) The hospital has a certificate of need from the state Department of Public Health and Human Services to provide swing-bed hospital services.

(f) The hospital does not have in effect a 24 hour nursing waiver under the provisions of 42 CFR 488.54(c).

(g) The hospital's Medicare or Medicaid swing-bed certification or approval has not been terminated within two years prior to the application for enrollment as a Medicaid swing-bed hospital services provider.

(h) The hospital meets the requirements of ARM 37.40.416(1).

(i) The hospital has applied for and the department has approved enrollment in the Medicaid program as a Medicaid swing-bed hospital services provider.

(i) As a condition of granting enrollment approval or of allowing continuing enrollment, the department may require a hospital to submit documentation or information relating to participation requirements.

(ii) The department may terminate a provider's swing-bed hospital services provider enrollment if it determines that the hospital is not in compliance with any of the requirements of this rule.

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, 2014 MAR p. 3085, Eff. 1/1/15.