Medicare and Medicaid Programs; new payment methodology for routine extended care services provided in a swing-bed hospital; correction--HCFA. Correction notice.

This document corrects the final rule published October 3, 1996 (61 FR 51611) that revised the methodology for payment of routine extended care services furnished in a swing-bed hospital. The final rule also revised the regulations concerning the method used to allocate hospital general routine inpatient service costs for purpose of determining payments to swing-bed hospitals.

Two measures for hospitals included in panel's legislation.

Health care reform legislation that recently cleared the House Ways and Means health subcommittee includes two measures that have been sought by hospitals--the restoration of separate payments to physicians for interpretation of electrocardiograms and the reauthorization of the federal grant program aimed at developing networks of primary-and acute-care hospitals in rural areas, known as the "each/peach" program.

Medicare program; swing-bed program changes--HCFA. Final rule.

This final rule responds to comments we received on an interim final rule relating to hospital swing beds that was published on September 7, 1989 (54 FR 37270). The interim rule expanded the swing-bed program to encompass rural hospitals with 50 to 99 beds. It established requirements that approved swing-bed hospitals with more than 49 beds must meet. This rule establishes the interim rules as final regulations with changes. These changes are based on our review and consideration of the public comments.

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).

Evaluation of the national swing-bed program in rural hospitals.

The Health Care Financing Administration (HCFA) implemented a swing-bed demonstration and evaluation program for rural communities in the 1970's. The demonstration substantiated the cost effectiveness of providing long-term care in small, rural, acute care hospitals. As a result, Section 904 of the Omnibus Reconciliation Act of 1980 (Public Law 96-499) authorized the national swing-bed program, allowing rural hospitals with fewer than 50 beds to provide Medicare- and Medicaid-covered swing-bed care. A congressionally mandated evaluation of the program was conducted and the national swing-bed program was found to be cost effective. In this article, HCFA's report and recommendations to Congress are summarized in the context of the evaluation findings. HCFA recommended that the program be continued and that consideration be given to extending the option to larger hospitals. In this regard, the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203) extended the program to include rural hospitals with up to 100 beds.