Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
Swing Bed Hospital Services (Nursing Facilities/Swing Beds)
State law allows Medicare payments for Swing Bed services provided by a designated licensed hospital, if the following criteria are met:
- The hospital is the sole community provider, or is a public hospital owned by a government entity with 15 or fewer acute care beds
- The PrimeWest Health member requires skilled nursing care per Medical Assistance (Medicaid) guidelines
- A nursing home bed is not available within 25 miles of the facility
- The member is transferred from an acute care hospital bed and acute care is no longer needed
- The member must receive a preadmission screening (PAS) prior to placement as specified in the Preadmission Screening (PAS) section below
- Hospital enrollment criteria can be found in Enrollment Requirements
- The Medicare Swing Bed Notification Form must be submitted to PrimeWest Health online or by fax to 1-866-431-0804 (toll free).
- Swing Bed services for Families and Children and MinnesotaCare members are not covered by PrimeWest Health.
- These stays are a carve-out benefit to the Minnesota Department of Human Services (DHS) and licensed facilities must obtain authorization from and bill DHS for Swing Bed services for Families and Children and MinnesotaCare members. Facilities can contact DHS at 1-800-366-5411 for more information.
Eligible Providers
To be eligible as a Swing Bed provider in the Medicare or Medical Assistance (Medicaid) program, providers must do the following:
- Receive Medicare certification as a Medicare Swing Bed provider. Medicare certification requires a survey by the Minnesota Department of Health (MDH). Certification information may be obtained from:
Minnesota Department of Health Facility and Providers Compliance Division
85 E 7th Place
PO Box 64900
Saint Paul, MN 55164
Phone: 1-651-215-8701 - Sign a Swing Bed Provider Agreement with DHS. Provider agreement information may be obtained from:
Minnesota Department of Human Services
Nursing Home Rates and Policy
PO Box 64973
Saint Paul, MN 55164-0973
Exceptions: Swing Bed services may be billed by a hospital not enrolled in the Medicare or Medical Assistance (Medicaid) program only in the case of a Qualified Medicare Beneficiary (QMB) receiving PrimeWest Senior Health Complete/Prime Health Complete Swing Bed services. Coinsurance and deductible on QMB claims will be paid for the length of the PrimeWest Senior Health Complete/Prime Health Complete approved stay. PrimeWest Health also covers up to 10 days of nursing care provided to a member in a Swing Bed if all the following are met:
- The member’s physician certifies that the member has a terminal illness or condition that is likely to result in death within 30 days and moving the member would not be in the best interests of the member and the member’s family
- A nursing home bed is not available within 25 miles of the facility
- An open bed is not available in any Medicare hospice program within 50 miles of the facility
Eligible Members
To be eligible for Swing Bed payment, there must be documentation that the member requires a level of skilled nursing care consistent with admission to an Long Term Care Facility ( LTCF) and no longer requires acute care hospital services. If the need for skilled nursing care cannot be documented, the services are not eligible for PrimeWest Health payment. A copy of the preadmission document must be attached to the claim.
Preadmission Screening (PAS)
All people seeking placement in a Swing Bed must be screened prior to admittance to a Swing Bed in accordance with the policy described in Preadmission Screening (PAS) Under State and Federal Statutes.
Limitations
In accordance with State law, payment for Swing Bed services for a PrimeWest Health member is limited to 40 days, unless the Commissioner of MDH grants an extension. Approval for services in excess of 40 days must be requested in writing from MDH at least 10 days before the end of the maximum 40-day stay. The extension approval must be attached to claims, which include service dates beyond the initial 40-day period. Eligible hospitals are allowed a total of 1,460 days of Swing Bed use per the State’s fiscal year (July 1 – June 30), provided that no more than 10 hospital beds are used as Swing Beds at any one time.
Ancillary Services
Routine care and services, similar to those provided in a nursing facility, are included in the daily Swing Bed payment rate. All other covered services may be billed to PrimeWest Health. All ancillary services must be billed in accordance with the respective guidelines for the service, as outlined in the appropriate sections of this Provider Manual.
PW_11-19_563
Updated_08/15/2022
