Recent Changes to Swing-Bed Regulations: Here’s What You Need to Know

Swing beds were first authorized by Congress in 1980. For those keeping count, that was four decades ago! Given the long-standing nature of the program, one might think it would be set in stone by now. But, that hasn’t been the case. In fact, swing bed regulations have changed twice just in the last 13 months. The most recent set of changes came in the Omnibus Burden Reduction (Conditions of Participation) Final Rule CMS-3346-F. The good news is, the changes, are seen as a net positive for hospitals and critical-access hospitals (CAHs) that provide swing-bed services.

This rule should save “providers an estimated 4.4 million hours of time previously spent on paperwork with an overall total projected savings to providers of $800 million annually,” according to a Centers for Medicare & Medicaid Services fact sheet.

The bad news? You’ll need to get up to speed on them—and fast. Some of the provisions in the latest rule have already taken effect. Here’s what you need to know:

Changes affecting all swing-bed providers (non-CAH and CAH):

Patients performing services: Many skilled nursing facilities (SNFs) encourage patients to perform services for their facilities, in an effort to provide engaging opportunities for occupational therapy. Previously, CMS gave swing-bed patients the right to choose to or refuse to perform services for the facility, whether on a paid or voluntary basis, but did not allow the facility to require such work. This requirement for a facility to request or allow swing-bed patients to perform services for the facility has been removed.

Patient activities programs: Like at an SNF, swing-bed programs were required to provide an ongoing activities programs, directed by a qualified professional. Under the new rule, that requirement has been removed, as CMS has recognized that the patient’s activity needs are addressed in the nursing care plan.

Social worker requirements: Previously, swing-bed facilities with more than 120 beds were required to employ a qualified social worker on a full-time basis due to hospital swing-bed and CAH bed limit requirements. This requirement has been removed.

Patient dental care: Under the new rule, swing-bed facilities are no longer required to assist residents in obtaining routine and 24-hour emergency dental care. This requirement was viewed by CMS as duplicative, given the existing requirement for hospitals and CAHs to provide care in accordance with the needs of the patient.

Swing-bed changes specific to CAHs

Policies and procedures review: CAHs offering swing-bed services were previously required to perform a review of all their policies and procedures on an annual basis. CMS has reduced the frequency of these reviews; they are now required every two years.

Disclosure of stakeholders: The new rule removes the duplicative requirement for CAHs to disclose the names of people with a financial interest in the CAH.

While most of the aforementioned changes represent a decrease in regulation, the final rule did add one requirement—to provide quality data to patients when they are admitted to a swing bed or discharged to another level of care.

For tips on getting your organization up to speed on these new standards, tune into the upcoming HealthTechS3 webinar, “Swing Bed Regulatory Requirements Revised—Again!”, taking place Friday, Jan. 24 at noon CST. During the webinar, Carolyn St. Charles, RN, BSN, MBA, chief regional clinical officer for HealthTechS3, will outline these changes in more detail and provide a quick review of previous changes that can help your facility maximize its swing-bed program. Register here.