26 Tex. Admin. Code § 554.2326 - Medicaid Swing Bed Program for Rural Hospitals
(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.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.