SPECIAL BULLETIN COVID-19 #115: Targeted Rate Increase and Associated Requirements for Swing Bed Services

Tuesday, July 21, 2020

NC Medicaid is implementing time-limited, targeted, enhanced swing bed reimbursement rates to provide additional financial support to hospitals that provide post-acute care services to COVID-19 positive (“COVID+”) Medicaid beneficiaries and non-COVID+ Medicaid beneficiaries transferred from other acute care hospitals as part of a surge response.  

A swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has approval from the Centers for Medicare and Medicaid Services (CMS) to provide post-hospital skilled nursing facility care.

The purpose of this Special Bulletin is to: 

  1. Confirm which providers are eligible for the enhanced swing bed rates;
  2. Describe the two-tiered enhanced rate structure; and
  3. Establish the steps for activating these enhanced rates and related reporting requirements.

This Special Bulletin does not otherwise modify the Medicaid requirements for swing bed services.

Providers Eligible for Swing Bed Enhanced Rates 

  • NC Medicaid enrolled hospitals that are also authorized by CMS to provide swing bed services according to 42 CFR 482.58.
  • Note: Hospitals that may establish temporary swing bed designation as reflected in CMS’ Hospitals: CMS Flexibilities to Fight COVID-19 are not eligible for the enhanced rates.

Swing Bed Enhanced Rates 

To help expand North Carolina’s post-acute care bed capacity, NC Medicaid is establishing two targeted, enhanced swing bed rates: one for a COVID+ beneficiary and one for a non-COVID+ beneficiary being moved as part of a surge response. These rates are applicable to post-acute services provided to Medicaid beneficiaries and only applicable on days that Medicaid is the primary payor for post-acute care. The rates provided here do not incorporate ventilator dependence level of need.

a) Enhanced Rate for Serving a COVID+ Medicaid Beneficiary 

The “COVID + Per Diem Rate” is $1,285.00. This rate is available when a swing bed is utilized to serve a Medicaid beneficiary, who is COVID+, as supported by the presence of the COVID-19 diagnosis code U07.1 on the claim for the dates of service that Medicaid is the primary payor.

This rate applies regardless of whether the swing bed provider admitted a COVID+ patient from another acute care facility or directly. 

This rate also applies to an admitted patient who subsequently is medically determined to be COVID+ and requires post-acute care.

b) Enhanced Rate for Serving Non-COVID+ Medicaid Beneficiary as Part of Surge Response

The “Surge Response Per Diem Rate” is $861.00. This rate is available when a swing bed is utilized to serve a Medicaid beneficiary who requires post-acute care and is transferred from another, separate acute care hospital. A hospital’s internal transfer of a non-COVID-19 patient into an activated swing bed is not eligible for this rate. 

Activating Enhanced Rates and Related Reporting Requirements

The enhanced rates are now active for those patients and bed days meeting the criteria established in this Special Bulletin. 

Rate activation is provider specific, based on the provider’s NPI. NC Medicaid will activate the applicable rate upon the provider’s initial submission of the Status Report Template for COVID-19-Related Swing-Bed Services to Medicaid.ProviderReimbursement@dhhs.nc.gov.  

To access the COVID+ enhanced rate, the COVID-19 diagnosis code U07.1, must also be reflected on applicable claims.

Once rates are activated, a provider will submit a monthly report for each month it is claiming either of the two rates reflected in this Special Bulletin.

Reporting is due on the 5th (or the following business day) of the month following the reporting period.

The swing bed report template and related instructions can be found here.

Technical Assistance Offered Tuesday, July 28 at 2 p.m.

NC Medicaid will offer a technical assistance session about these time-limited rate enhancements and related reporting requirements on Tuesday, July 28, 2020, from 2 to 3 p.m. ET. Providers interested in attending may register here.

Note: Providers will receive a rate letter from Provider Reimbursement confirming the increased rate and its effective date for the reported beneficiaries.