Medicare program; swing-bed program changes--HCFA. Interim rule with comment period

These interim rules revise the current Medicare rules relating to approved swing-bed hospitals. They expand the allowable rural hospital bed size from 49 beds to 99 beds. They require approved swing-bed hospitals with more than 49 beds t:--Transfer extended care hospital patients within 5 days to an available skilled nursing facility (SNF) bed in the geographic region, unless the patient's physician certifies within the 5 day period that transfer is not medically appropriate; --Have availability agreements with SNFs in their geographic region, concerning the availability of extended care beds and the transfer of extended care patients; and --Not seek Medicare payment for those patient days of extended care services (in a cost reporting period) that exceed 15 percent of the product of the number of days in the period and the average number of licensed beds at the hospital. An exception to this provision is that Medicare payment will continue to be made for those patients who are receiving extended care services at the time the hospital reaches the above-mentioned limit. These regulations also require that SNFs in the geographic region of an approved swing-bed hospital must provide notice to the hospital of the availability of SNF beds. These provisions conform our regulations with changes made by section 4005(b) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203) and section 411(b)(4)(D) of the Medicare Catastrophic Coverage Act of 1988 (Pub. L. 100-360).