Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-46 - HOSPICE CARE
Section 560-X-46-.08 - Admission And Periodic Review

(1) The Medicaid Medical and Quality Review Unit or designee will perform admission review of all Medicaid admissions to ensure the necessity and appropriateness of the admission and that a physician has certified on the date of admission, the need for swing bed care. Medicaid or its designee will certify the level of care required by the patient at the time of admission by utilizing Form 199.

(2) For applications which are not approved by the Medical and Quality Review Unit or its designee, a Medical Director, will review and either approve or deny the medical eligibility.

(3) Recipients must meet Skilled Nursing Facility (SNF) medical and financial requirements for swing bed admissions just as they are required for SNF admissions. Refer to Chapter 10 and Chapter 25.

(4) For recipients who receive retroactive Medicaid eligibility while utilizing swing bed services, the hospital should furnish all doctors' orders, progress and nurses' notes for the time in question to Medicaid's fiscal agent.

(5) Medical approvals may be issued by the Medicaid Medical and Quality Review Unit or designee if the information provided to Medicaid documents the need for SNF care and the recipient meets criteria set forth in Rule 560-X-10-.10 for SNF care.

(6) Continued stay reviews are required to assure the necessity and appropriateness of skilled care and effectiveness of discharge planning. Recertification of SNF patients is required 30, 60, and 90 days after admission and then every 60 days thereafter. Physicians must state "I certify" and specify that the patient requires skilled care for continued stay in the facility. Facilities must have written policies and procedures for recertification.

(7) Reimbursement requires a 3-day qualifying stay in any acute care hospital prior to admission to a swing bed in any hospital. The swing-bed stay must fall within the same period of illness as the qualifying stay.