Current through Register Vol. 18, September 20, 2024
(1) Before admitting a Medicaid recipient to
a swing-bed, the swing-bed hospital must meet all of the following
requirements:
(a) the hospital must obtain a
preadmission screening to determine the level of care required by the patient's
medical condition. Medicaid will not reimburse a provider for swing-bed
hospital services provided to a Medicaid recipient admitted to a swing-bed
unless the recipient meets the nursing facility level of care requirements
specified in ARM
37.40.202 and
37.40.205. The swing-bed hospital
must ensure that form DPHHS-SLTC-61, "screening notification", is completed by
the department preadmission screening team to document the level of care
determination.
(b) Except when a
waiver is obtained under (4), the hospital must determine that no appropriate
nursing facility bed is available to the Medicaid patient within a 25 mile
radius of the swing-bed hospital. The hospital is required to maintain written
documentation of inquiries to nursing facilities about the availability of a
nursing facility bed and indicating that if a bed is not available, the
hospital will provide swing-bed services to the patient. The swing-bed hospital
is encouraged to enter into availability agreements with Medicaid-participating
nursing facilities in its geographic region that require the nursing facility
to notify the hospital of the availability of nursing facility beds and dates
when beds will be available.
(i) For purposes
of this rule, an "appropriate" nursing facility bed is a bed in a
Medicaid-participating nursing facility which provides the level of care
required by the recipient's medical condition.
(2) A Medicaid patient admitted to a
swing-bed must be discharged to an appropriate nursing home bed within a 25
mile radius of the swing-bed hospital within 72 hours of an appropriate nursing
home bed becoming available.
(3)
The requirements of (1)(b) and (2) apply regardless of the 30-day notice
requirement generally applicable to transfers and discharges under ARM
37.40.420(1).
When an appropriate nursing facility bed is or becomes available, the provider
must provide notice as required by ARM
37.40.420(5)(f)
and must otherwise comply with the requirements of ARM
37.40.420(1) to
the extent practicable in the time available before transfer to the nursing
facility bed.
(4) A provider may
request a waiver of the determination requirement of (1)(b) for an acute care
patient of the swing-bed hospital or may request for a swing-bed patient a
waiver of the transfer requirement of (2) when the recipient's attending
physician verifies in writing that either the recipient's condition would be
endangered by transfer to an appropriate nursing facility bed within a 25 mile
radius of the swing-bed hospital or that the individual has a medical prognosis
that his or her life expectancy is six months or less if the illness runs its
normal course.
(a) The waiver request and
physician's written verification must be submitted to the Department of Public
Health and Human Services, Senior and Long Term Care Division, 2030 11th
Avenue, P.O. Box 4210, Helena, MT 59640-4210. Waiver approvals granted by
county offices will not be valid or effective for purposes of this
rule.
(b) The waiver request and
physician's written verification must be received by the nursing facility
services bureau within five working days of admission to the swing-bed or
within five days of availability of an appropriate nursing facility bed and the
provider must obtain written approval from the Medicaid services bureau prior
to billing for services provided after the date of admission to the swing-bed
or the date of availability of an appropriate nursing facility bed.
(5) The department may
retrospectively review the use of swing-bed services provided to Medicaid
patients and may deny payments when it is determined that the requirements of
this rule were not met.
53-2-201,
53-6-113,
MCA; IMP,
53-2-201,
53-6-101,
53-6-111,
53-6-113,
53-6-141,
MCA;
