Lesson 3 Medicaid Services Swing Beds
Medicaid Coverage • Georgia Medicaid will cover swing-bed services for recipients who require a nursing facility level of care on a DAILY basis. • A physician must certify that the nursing facility care is needed. • The certification must be obtained at the time of admission to the swing-bed, or on the next working day if admitted on a weekend or holiday.
Medicaid Coverage • Changes in recipient status (discharge, termination etc.) must be reported to the Department of Family Services office on a Form DMA-59.
Medicaid Reimbursement • The Medicaid reimbursement rate is all-inclusive and covers: • Room and Board • Laundry • Nursing and routine services • All nursing services (excluding private duty nurses) • Most ancillary services
Limits to Swing-Bed Coverage • If the hospital has more than 49 beds but less than 100 beds, it cannot keep a Medicaid patient in a swing-bed for more than five days beyond the later of: • Any date on which a bed is available for the patient in a nursing facility (NF) located within the hospital geographic region • The date that a hospital learns that a (NF) bed is available, or • The date the facility is notified that a (NF) bed will become available.
Limits to Swing-Bed Coverage • These swing-bed facilities must transfer swing-bed patients within five (5) days (excluding holidays and weekends) for an available SNF bed in the geographic region unless • Physician certifies the transfer is not medically appropriate. • Hospitals with less than 50 beds are not required to transfer.
Medicare / Medicaid • If a patient is covered under Medicare and Medicaid, the swing-bed facility must bill Medicare prior to billing Medicaid. • Medicare will reimburse for the first twenty days at 100% of the Medicare rate.
Medicaid Coinsurance • For the 21st to 100th day of skilled coverage, Medicare will pay a reduced amount and Medicaid will pay the applicable coinsurance amount. • 1/8 of inpatient patient deductible • The Medicaid coinsurance amount cannot exceed the Medicaid allowed amount.
Medicaid Coinsurance • Before Medicaid will pay coinsurance, the hospital must have • Approved/paid Medicare Remittance Advice and • A UB-04 Claim form. To obtain detailed specifics, please refer to the Billing Manual and the Category of Service specific policy manuals posted on the GHP Web Portal at www.ghp.georgia.gov.