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Critical Access Hospital Swing Bed Regulations

A critical access hospital (CAH) is a rural hospital that is certified to receive cost-based reimbursement from Medicare, which is intended to improve the hospital's performance and reduce the number of hospital closures. Certain CAHs may enter into a "swing bed agreement." This is a program in which recovering patients or patients who are no longer critically ill may stay longer in the same hospital facility instead of switching to another hospital or being discharged. These swing beds may also be used for skilled nursing facility (SNF) care.

  1. CAH Certification

    • A hospital may become a critical access hospital if it fits the criteria set by the Centers for Medicare and Medicaid Services (CMS). CAHs must be located in a state in which the CMS has established a Medicare rural hospital flexibility program and must be designated as a CAH by that state. These hospitals must be in a rural area that is located at least 35 miles from any other hospital or CAH--15 miles in challenging terrain--and cannot have more than 25 inpatient beds. Average stays in these hospitals must not exceed 96 hours.

    Skilled Nursing Facility Requirements

    • Skilled nursing is a type of health care given when skilled nursing or rehabilitation staff are needed to manage, observe and evaluate care. In order to provide these services, CAHs must be in compliance with SNF guidelines. The guidelines deal primarily with residents' rights, including admission, transfer and discharge rights, patient activities, social services, specialized rehabilitation centers, dental services and nutrition.

    Swing Bed Regulations

    • The Social Security Act permits CAHs to enter into a swing bed agreement when the hospital has fewer than 25 beds for acute patient care. These swing beds may be used as needed to provide more acute care instead of discharging patients too soon due to lack of beds. Beds that are not included in this count are exam tables, stretchers, operating room tables, ICU and newborn beds, among others.

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