Swing-Bed

Published

March 30, 2026

Hospital Providers of Extended Care Services (“Swing-Beds”):

“Swing-bed” is a reimbursement term that means the care and reimbursement for the care of a patient in a small rural hospital or CAH “swings” from acute care to post hospital skilled nursing care (SNF). A swing-bed hospital means a hospital or CAH participating in Medicare that has an approval from CMS to provide post hospital SNF care and meets the requirements specified in §482.66 for a hospital or §485.645 for a CAH.

Certification to provide swing-beds is an approval separate from the certification to operate as a hospital or CAH. When a survey of swing-beds is completed, any deficiencies and Plans of Correction (PoC) must be documented on a separate Form CMS-2567. If the swing-beds are voluntary terminated or terminated by CMS, that action does not affect the continuing operation of the provider as a hospital or CAH. It terminates the approval to operate and receive reimbursement for the swing-beds.

The swing-beds in a hospital or CAH do not have to be separated from the acute patients although the facility may choose to do so. The patients do not have to move to a different location in the facility when changing from acute care status to swing-bed status unless the facility requires it.

There is no length of stay restriction for a swing-bed patient whether they are in a hospital or a CAH. There is no required discharge to a nursing home and no transfer agreement. Patients may be discharged to a nursing home as part of discharge planning, but it is not required.

A medical order in the chart by the physician is required to change status from acute care to swing-bed because the patient is being discharge from acute care status and admitted to swing-bed status. This is necessary for reimbursement purposes because the billing and reimbursement change or “swing.” Accordingly, the facility is given a subprovider number for billing swing-bed services.

For Medicare patients, a 3-day qualifying stay in any hospital or CAH is required to prior to admission to a swing-bed and the admission must be for treatment of the same condition. This 3-day qualifying stay only applies to a Medicare patient.

Section 1883 of the Act authorizes payment under Medicare for post-hospital SNF services provided by any hospital that meets the following requirements at 42 CFR 482.66. These requirements include the following.

Calculation of Bed Count

Exclude from the bed count newborn and intensive care beds. A hospital licensed for more than 100 beds may be eligible for swing-bed approval if it utilizes and staffs for fewer than 100 beds. The SA forwards to the RO documentation that the hospital is operating within the bed category. Include in the packet floor plans, bed assignments by room number, staffing schedules, and census information for the previous 12 months.

The SA obtains written assurance from appropriate hospital officials that the hospital will not operate with a greater number of inpatient hospital beds than permitted by the category for which approval is requested.

--- output: html_document editor_options: chunk_output_type: console --- # Swing-Bed ```{r setup} #| message: false #| warning: false #| echo: false #| cache: false #| comment: "" library(ccn) source("code/gt_theme.R") ``` <br> Hospital Providers of Extended Care Services ("Swing-Beds"): "Swing-bed" is a reimbursement term that means the care and reimbursement for the care of a patient in a small rural hospital or CAH "swings" from acute care to post hospital skilled nursing care (SNF). A swing-bed hospital means a hospital or CAH participating in Medicare that has an approval from CMS to provide post hospital SNF care and meets the requirements specified in §482.66 for a hospital or §485.645 for a CAH. Certification to provide swing-beds is an approval separate from the certification to operate as a hospital or CAH. When a survey of swing-beds is completed, any deficiencies and Plans of Correction (PoC) must be documented on a separate Form CMS-2567. If the swing-beds are voluntary terminated or terminated by CMS, that action does not affect the continuing operation of the provider as a hospital or CAH. It terminates the approval to operate and receive reimbursement for the swing-beds. The swing-beds in a hospital or CAH do not have to be separated from the acute patients although the facility may choose to do so. The patients do not have to move to a different location in the facility when changing from acute care status to swing-bed status unless the facility requires it. There is no length of stay restriction for a swing-bed patient whether they are in a hospital or a CAH. There is no required discharge to a nursing home and no transfer agreement. Patients may be discharged to a nursing home as part of discharge planning, but it is not required. A medical order in the chart by the physician is required to change status from acute care to swing-bed because the patient is being discharge from acute care status and admitted to swing-bed status. This is necessary for reimbursement purposes because the billing and reimbursement change or "swing." Accordingly, the facility is given a subprovider number for billing swing-bed services. For Medicare patients, a 3-day qualifying stay in any hospital or CAH is required to prior to admission to a swing-bed and the admission must be for treatment of the same condition. This 3-day qualifying stay only applies to a Medicare patient. Section 1883 of the Act authorizes payment under Medicare for post-hospital SNF services provided by any hospital that meets the following requirements at 42 CFR 482.66. These requirements include the following. ### Calculation of Bed Count Exclude from the bed count newborn and intensive care beds. A hospital licensed for more than 100 beds may be eligible for swing-bed approval if it utilizes and staffs for fewer than 100 beds. The SA forwards to the RO documentation that the hospital is operating within the bed category. Include in the packet floor plans, bed assignments by room number, staffing schedules, and census information for the previous 12 months. The SA obtains written assurance from appropriate hospital officials that the hospital will not operate with a greater number of inpatient hospital beds than permitted by the category for which approval is requested.