Medicare Skilled Nursing Facility PPS Swing Bed Providers

The Social Security Act (the Act) permits certain small, rural hospitals to enter into a swing bed agreement, under which the hospital can use its beds, as needed, to provide either acute or skilled nursing facility (SNF) care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Medicare Part A (the hospital insurance program) covers post-hospital extended care services furnished in a swing bed hospital.

In accordance with the Balanced Budget Act (BBA) of 1997, the SNF-level services of non-CAH swing bed facilities are covered under the SNF prospective payment system (PPS) effective with cost reporting periods beginning on or after July 1, 2002. This applies to short term hospitals, long term hospitals, and rehabilitation hospitals certified as swing bed hospitals. The SNF-level services of CAHs with swing beds are exempt from the SNF PPS, in accordance with the Benefits Improvement and Protection Act of 2000 and the Medicare Modernization Act of 2003, and are instead paid based on 101 percent of reasonable cost. To qualify for SNF-level services, a beneficiary is required to receive acute care as a hospital inpatient covered under Medicare Part A for a medically necessary stay of at least 3 consecutive calendar days.

The SNF PPS covers all costs (ancillary, routine, and capital) related to covered services furnished to beneficiaries under Medicare Part A. Like the PPS for inpatient hospital services, the SNF PPS excludes certain specified services, which are separately billable to Part B. The SNF PPS relies on information from a resident assessment instrument to classify residents into payment categories based on patient characteristics (see the  Patient Driven Payment Model page for more information).  Non-CAH swing bed hospitals are required to complete the MDS assessment to meet this requirement. There is no longer a separate Swing Bed MDS assessment manual. Swing Bed MDS forms and manuals archived in the files below are for historic record and context only. See the MDS page in the Related Links below for the most current forms and manuals used by both SNFs and Swing Bed providers for SNF PPS reimbursement.