| (a) Program description. HHSC operates the Medicaid
Swing Bed Program for rural hospitals located in counties with populations
of 100,000 or less. The Medicaid Swing Bed Program is modeled on Medicare's
Swing Bed Program. The Medicaid Swing Bed Program permits participating
rural hospitals to use their beds interchangeably to furnish both
acute hospital care and nursing facility care to Medicaid recipients,
when no care beds are available in nursing facilities (NFs) in the
area. When a participating rural hospital furnishes NF nursing care
to Medicaid recipients, HHSC makes payment to the hospital using the
same procedures and the same Resource Utilization Group daily rates
that the Texas Health and Human Services Commission authorizes for
reimbursing NFs participating in the Texas Medicaid Nursing Home Program.
(b) Application to participate. Rural hospitals apply
to HHSC to participate in the Medicaid Swing Bed Program. Each applicant
must be located in a county with a population of 100,000 or less and
must meet the qualifying requirements of the Medicare Swing Bed Program.
Hospitals approved for participation enter into swing bed provider
agreements with HHSC.
(c) Parallel participation in Medicare. A rural hospital
participating in the Medicaid Swing Bed Program must:
(1) have a Medicare hospital provider agreement; and
(2) be Medicare-certified as a swing bed hospital in
the Medicare Swing Bed Program.
(d) Applicability of Medicare requirements. Each participating
rural hospital must satisfy all the requirements of the Medicare Swing
Bed Program, except that Medicare's five-weekday transfer requirement
and 15 percent payment limitation, as stated in 42 CFR §413.114(d)(2),
do not apply for Medicaid reimbursement purposes.
(e) Applicability of NF requirements. From day one
of the resident's stay, a rural hospital participating in the Medicaid
Swing Bed Program must meet the requirements set forth in §554.2304(c)
of this chapter (relating to Contract Requirements); §§554.2601
- 554.2608 and 554.2610 of this chapter (relating to Vendor Payment
(Items and Services Included), Additional Charges (Items and Services
Excluded from Vendor Payment), Therapeutic Home Visits Away from the
Facility, Vendor Payment Information, Effective Date of Vendor Coverage,
Supplementation of Vendor Payments, Penalties for Supplementation,
Limitations on Provider Charges, and Medicare part A Skilled Nursing
Facility Deductible and Coinsurance Payment); and Subchapter Y of
this chapter (relating to Medical Necessity Determinations).
(f) Rural hospital (Medicaid swing bed facility) licensure
and certification requirements. Pursuant to Texas Health and Safety
Code §222.024 concerning the duplication of health care inspections
and licensing, a rural hospital participating in the Medicaid Swing
Bed Program satisfies licensure and certification requirements referenced
in this section when it is currently licensed and certified as a hospital.
However, in accordance with Texas Human Resources Code, §32.024,
if the rural hospital's swing beds are used for more than one 30-day
length of stay per year, per resident the hospital must comply with
the full Nursing Facility Requirements.
(g) Rural hospital (Medicaid swing bed facility) administrator.
The governing body of a rural hospital participating in the Medicaid
Swing Bed Program satisfies the requirement to appoint a qualified
full-time nursing facility administrator, found at §554.1902(b)
of this chapter (relating to Governing Body), when it appoints a hospital
administrator as its official representative and designates the administrator's
responsibilities and authority, subject to the following exception.
If the swing beds are used for more than one 30-day length of stay
per year, per resident, the hospital's governing body must appoint
a full-time licensed nursing facility administrator.
(h) Rural hospital (Medicaid swing bed facility) staff
development requirements. A rural hospital participating in the Medicaid
Swing Bed Program satisfies the staff development requirements found
at §554.1929 of this chapter (relating to Staff Development)
if the swing beds are used for no more than one 30-day length of stay
per year, per resident.
(i) Rural hospital (Medicaid swing bed facility) transfer
agreement. A rural hospital participating in the Medicaid Swing Bed
Program is not required to have a transfer agreement with another
hospital, as required by §554.1915 of this chapter (relating
to Transfer Agreement).
(j) Rural hospital geographic region. The phrase "a
participating rural hospital's geographic region" refers to an area
that includes nursing facilities with which the hospital normally
arranges transfers and all other nursing facilities in similar proximity
to the hospital. If a hospital has no previous transfer practices
on which to base a determination, the phrase "geographic region" refers
to an area that includes all nursing facilities within 50 miles of
the hospital except for facilities that the hospital demonstrates
to be inaccessible to its patients.
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| Source Note: The provisions of this §554.2326 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective July 1, 1996, 21 TexReg 4408; amended to be effective September 1, 2008, 33 TexReg 7264; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871; amended to be effective December 6, 2022, 47 TexReg 7712 |
