Swing Beds

1. Lesson 3 Medicaid Services Swing Beds

2. Medicaid Coverage • Georgia Medicaid will cover swing-bed services for recipients who require a nursing facility level of care on a DAILY basis. • A physician must certify that the nursing facility care is needed. • The certification must be obtained at the time of admission to the swing-bed, or on the next working day if admitted on a weekend or holiday. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

3. Medicaid Coverage • Changes in recipient status (discharge, termination etc.) must be reported to the Department of Family Services office on a Form DMA-59. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

4. Medicaid Reimbursement • The Medicaid reimbursement rate is all-inclusive and covers: • Room and Board • Laundry • Nursing and routine services • All nursing services (excluding private duty nurses) • Most ancillary services *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

5. Limits to Swing-Bed Coverage • If the hospital has more than 49 beds but less than 100 beds, it cannot keep a Medicaid patient in a swing-bed for more than five days beyond the later of: • Any date on which a bed is available for the patient in a nursing facility (NF) located within the hospital geographic region • The date that a hospital learns that a (NF) bed is available, or • The date the facility is notified that a (NF) bed will become available. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

6. Limits to Swing-Bed Coverage • These swing-bed facilities must transfer swing-bed patients within five (5) days (excluding holidays and weekends) for an available SNF bed in the geographic region unless • Physician certifies the transfer is not medically appropriate. • Hospitals with less than 50 beds are not required to transfer. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

7. Medicare / Medicaid • If a patient is covered under Medicare and Medicaid, the swing-bed facility must bill Medicare prior to billing Medicaid. • Medicare will reimburse for the first twenty days at 100% of the Medicare rate. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

8. Medicaid Coinsurance • For the 21st to 100th day of skilled coverage, Medicare will pay a reduced amount and Medicaid will pay the applicable coinsurance amount. • 1/8 of inpatient patient deductible • The Medicaid coinsurance amount cannot exceed the Medicaid allowed amount. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

9. Medicaid Coinsurance • Before Medicaid will pay coinsurance, the hospital must have • Approved/paid Medicare Remittance Advice and • A UB-04 Claim form. To obtain detailed specifics, please refer to the Billing Manual and the Category of Service specific policy manuals posted on the GHP Web Portal at www.ghp.georgia.gov. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

10. Medicaid Billing • If a Medicare/Medicaid patient’s Medicare Part A benefits are exhausted: • swing-bed services may be submitted to Medicaid for reimbursement at the Medicaid per diem rate established by the Department. • Claims must be filed on the UB-04 Claim Form and submitted within six (6) months from month of service. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

11. Medicaid Billing • The UB-04 claim form should be filed with the Medicare Explanation of Benefits attached. • The attachment must state the patient’s Medicare benefits are exhausted and include the last date of Medicare entitlement. • Claims may be submitted via mail or web. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

12. Reimbursement • Swing-bed providers will be reimbursed a prospective rate per patient day. • This rate is the statewide average Medicaid per diem paid to skilled nursing facilities for routine services furnished during the previous calendar year. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

13. Medicaid Manual • Routine services are defined in the Medicaid Policies and Procedures for Swing Bed Services. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

14. All nursing services (excluding private duty nurses), medical social services, physical therapy, speech therapy, restorative nursing care, tray service, durable medical equipment (includes but is not limited to beds, bed rails, walkers, wheelchairs), incontinency care and incontinency pads, hand feedings, special mattresses and pads, massages, syringes, enemas, nursing supplies and dressings, extra linens, assistance in personal care and grooming, laboratory procedures not requiring laboratory personnel, non-prescription drugs such as antacids, aspirin, suppositories, milk of magnesia, mineral oil, rubbing alcohol, prophylactic medications (i.e., influenza vaccine, etc.), and other items not on the Medical Assistance Drug List but which are distributed or used individually as ordered by the attending physician, and routine personal hygiene items and services including but not limited to shampoo, hair conditioner, comb, brush, bath soap non-legend disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razors, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, petroleum jelly, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, towels, washcloths, hospital gowns, nail care, hair care, bathing, and shaving. In addition, supplies such as oxygen, catheters, catheter sets, drainage apparatus, intravenous solutions, administration sets and water for injections are to be covered under the approved reimbursement rate.

15. Reimbursement • Ancillary services such as laboratory, radiology and certain prescription drugs must be billed and reimbursed separately under the appropriate Medicaid program. • For example, radiology services provided in the outpatient department of the hospital should be billed as hospital outpatient services. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

16. Reimbursement • Medicaid will reimburse the Medicare Part A coinsurance for Medicare/Medicaid recipients. • Medicaid reimbursement will be reduced by the recipient’s liability. • The hospital is responsible for collecting the recipients liability portion. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

17. Medicaid Cost Reports • There will not be a year-end cost report settlement for swing-bed services. • There is no swing-bed services cost report. • Medicaid swing-bed program data should not be included in the Medicaid Cost Report settlement data. • The Medicaid routine swing-bed days should be excluded from the hospital’s Medicaid routine days on the cost report. *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.

18. Comparison MEDICAID SWING BED *Note: All references to Medicaid refer to Georgia Medicaid. Please reference your state Medicaid regulations for all Medicaid specific instruction.