CMS Releases Additional Guidance on COVID-19 Blanket Swing Bed Waivers

May 27, 2020

On May 20, the Centers for Medicare & Medicaid Services (CMS) released new guidance for hospitals requesting Medicare approval for swing beds as a hospital service. Swing beds provide skilled nursing facility (SNF)-level care for hospitalized patients who do not need acute-level care but cannot find nursing home placement during the COVID-19 public health emergency (PHE). Members should evaluate whether swing beds provide an interim solution to accommodate patients who are clinically ready for discharge to a SNF but test positive for COVID-19 (see ML-88 for additional information).

GNYHA has highlighted key takeaways from the swing bed guidance below.

Swing Bed Waiver Background

On May 8, CMS issued new blanket waivers to provide flexibilities to care for patients during the COVID-19 PHE. One of these waivers expanded a hospital’s ability to provide long-term care services (swing beds) to patients who do not require acute care but meet the threshold for SNF care. CMS waived certain eligibility requirements for hospital providers of swing beds to allow hospitals to establish swing beds as payable under the SNF prospective payment system (PPS). Swing bed services, traditionally only provided by small rural and critical access hospitals (CAHs), can now be added by any Medicare-certified enrolled hospital, except psychiatric and long-term acute care hospitals.

Requesting Approval for Swing Beds

Under the swing bed waiver, hospitals must call the Medicare provider enrollment hotline to add swing bed services. Upon calling the enrollment hotline, hospitals must attest to CMS that:

  • they have made a good faith effort to exhaust all other options
  • there are no SNFs within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing or able to accept patients because of the COVID-19 PHE
  • the hospital meets all waiver eligibility requirements
  • they have a plan to discharge patients as soon as practicable when a SNF bed becomes available or when the PHE ends, whichever is earlier

Additionally, to qualify for this waiver, hospitals must:

  • not use SNF swing beds for acute level care
  • comply with all other hospital conditions of participation and those SNF provisions set out in 42 CFR 482.58(b) to the extent not waived
  • be consistent with the state’s emergency preparedness or pandemic plan

Designating Swing Bed Services

Hospitals do not have to locate their swing beds in a special section of the facility unless the hospital requires it. Approved hospitals may use any acute care inpatient bed within the hospital to provide swing bed services. To properly document the acute care discharge and admission to the swing bed, all information should be maintained in the beneficiary’s medical record. The record must include:

  • acute care discharge orders, including a discharge summary
  • admission orders to swing bed status (whether the beneficiary stays in the same hospital or CAH or transfers to an approved swing bed hospital or CAH)
  • appropriate progress notes

Swing Beds and Minimum Data Set (MDS) Assessments

CMS states “Hospitals must complete comprehensive assessments of a swing bed patient’s needs, strengths, goals, life history and preferences, using the MDS Resident Assessment Instrument (RAI) specified by CMS for patients receiving a SNF level of care.” Hospitals (except CAHs) must complete the MDS Swing Bed Assessment for each patient to be paid under the SNF PPS. Hospitals can use CMS’s Resident Assessment Validation and Entry System (jRAVEN) to collect and maintain MDS assessment data for submissions to the appropriate state and/or national data repository.

To learn more about about the MDS RAI, please find the MDS RAI manual here or contact your Medicare Administrative Contractor or state RAI coordinator (listed in Appendix B of the MDS RAI manual). For questions about jRAVEN, please call (800)-339-9313 or e-mail

Billing and Reimbursement for Swing Beds

Hospitals billing for SNF-level swing bed services will be paid under the SNF PPS. Using the SNF PPS Patient Driven Payment Model classification system, payment rates will be based on a patient’s case-mix group determined by information entered in a patient’s MDS RAI. The SNF PPS covers all SNF services provided to beneficiaries in a Medicare Part A-covered SNF stay except certain specialized services, which are billable to Part B.

Please find instructions for swing bed billing in the Medicare Claims Processing Manual here.