[Code of Federal Regulations]
[Title 42, Volume 3, Parts 430 to End]
[Revised as of October 1, 1999]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR482.66]

[Page 372-373]
 
PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS--Table of Contents
 
             Subpart E--Requirements for Specialty Hospitals
 
Sec. 482.66  Special requirements for hospital providers of long-term care services (``swing-beds'').

    A hospital that has a Medicare provider agreement must meet the 
following requirements in order to be granted an approval from HCFA to 
provide post-hospital extended care services, as specified in 
Sec. 409.30 of this chapter, and be reimbursed as a swing-bed hospital, 
as specified in Sec. 413.114 of this chapter:
    (a) Eligibility. A hospital must meet the following eligibility 
requirements:
    (1) The facility has fewer than 100 hospital beds, excluding beds 
for newborns and beds in intensive care type inpatient units (for 
eligibility of hospitals with distinct parts electing the optional 
reimbursement method, see Sec. 413.24(d)(5) of this chapter).
    (2) The hospital is located in a rural area. This includes all areas 
not delineated as ``urbanized'' areas by the Census Bureau, based on the 
most recent census.
    (3) When required by State in which it is located, the hospital has 
been granted a certificate of need for the provision of long-term care 
services from the State health planning and development agency 
(designated under section 1521 of the Public Health Service Act).
    (4) The hospital does not have in effect a 24-hour nursing waiver 
granted under Sec. 488.54(c) of this chapter.
    (5) The hospital has not had a swing-bed approval terminated within 
the two years previous to application.
    (6) A hospital with more than 49 beds (but fewer than 100) approved 
under this section after March 31, 1988, must--
    (i) Unless a Medicare-participating SNF is not available or the SNFs 
are not willing to enter into an agreement when one is offered, have an 
availability agreement with each SNF in its geographic region that 
requires the SNF to notify the hospital of the availability of 
posthospital SNF care beds and the dates when those beds will be 
available; and
    (ii) Transfer the extended care patient within 5 days (excluding 
weekends and holidays) after learning that a SNF bed is available or in 
the case of prospective notification by the SNF, within 5 days of the 
date the bed becomes available, unless the patient's physician 
certifies, as required under Sec. 424.20, that the transfer is not 
medically appropriate.
    (7) The hospital must provide written assurance to HCFA that the 
hospital will not operate over 49 or over 99 beds except in connection 
with a catastrophic event. The hospital bed count is determined as 
follows:
    (i) A hospital bed count is calculated by excluding from the count, 
beds that because of their special nature, such as newborn and intensive 
care beds, would not be available for swing-bed use. Also

[[Page 373]]

excluded from the bed count are beds in separately certified ``distinct 
part'' SNFs and NFs and beds in a psychiatric or rehabilitation unit 
that is excluded from the prospective payment system.
    (ii) A hospital licensed for more than 49 or 99 beds, is considered 
to have the number of beds that it consistently utilizes and staffs. 
Hospitals, at a minimum, document their count by staffing schedules and 
census information for the previous 12 months before application to be a 
swing-bed hospital.
    (b) Skilled nursing facility services. The facility is substantially 
in compliance with the following skilled nursing facility requirements 
contained in subpart B of part 483 of this chapter.
    (1) Resident rights (Sec. 483.10 (b)(3), (b)(4), (b)(5), (b)(6), 
(d), (e), (h), (i), (j)(1)(vii), (j)(1)(viii), (l), and (m)).
    (2) Admission, transfer, and discharge rights (Sec. 483.12 (a)(1), 
(a)(2), (a)(3), (a)(4), (a)(5), (a)(6), and (a)(7)).
    (3) Resident behavior and facility practices (Sec. 483.13).
    (4) Patient activities (Sec. 483.15(f)).
    (5) Social services (Sec. 483.15(g)).
    (6) Discharge planning (Sec. 483.20(e)).
    (7) Specialized rehabilitative services (Sec. 483.45).
    (8) Dental services (Sec. 483.55).

[51 FR 22042, June 17, 1986; 51 FR 27848, Aug. 4, 1986, as amended at 51 
FR 34833, Sept. 30, 1986; 54 FR 37275, Sept. 7, 1989; 56 FR 54546, Oct. 
22, 1991; 59 FR 45403, Sept. 1, 1994]