[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR485.645]



[Page 612-613]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table 

of Contents

 

 Subpart F_Conditions of Participation: Critical Access Hospitals (CAHs)

 

Sec. 485.645  Special requirements for CAH providers of long-term care 

services (``swing-beds'')



    A CAH must meet the following requirements in order to be granted an 

approval from CMS to provided post-hospital SNF care, as specified in 

Sec. 409.30 of this chapter, and to be paid for SNF-level services, in 

accordance with paragraph (c) of this section.

    (a) Eligibility. A CAH must meet the following eligibility 

requirements:

    (1) The facility has been certified as a CAH by CMS under Sec. 

485.606(b) of this subpart; and

    (2) The facility provides not more than 25 inpatient beds. Any bed 

of a unit of the facility that is licensed as a distinct-part SNF at the 

time the facility applies to the State for designation as a CAH is not 

counted under paragraph (a) of this section.

    (b) Facilities participating as rural primary care hospitals (RPCHs) 

on September 30, 1997. These facilities must meet the following 

requirements:



[[Page 613]]



    (1) Notwithstanding paragraph (a) of this section, a CAH that 

participated in Medicare as a RPCH on September 30, 1997, and on that 

date had in effect an approval from CMS to use its inpatient facilities 

to provide post-hospital SNF care may continue in that status under the 

same terms, conditions and limitations that were applicable at the time 

those approvals were granted.

    (2) A CAH that was granted swing-bed approval under paragraph (b)(1) 

of this section may request that its application to be a CAH and swing-

bed provider be reevaluated under paragraph (a) of this section. If this 

request is approved, the approval is effective not earlier than October 

1, 1997. As of the date of approval, the CAH no longer has any status 

under paragraph (b)(1) of this section and may not request reinstatement 

under paragraph (b)(1) of this section.

    (c) Payment. Payment for inpatient RPCH services to a CAH that has 

qualified as a CAH under the provisions in paragraph (a) of this section 

is made in accordance with Sec. 413.70 of this chapter. Payment for 

post-hospital SNF-level of care services is made in accordance with the 

payment provisions in Sec. 413.114 of this chapter.

    (d) SNF services. The CAH is substantially in compliance with the 

following SNF requirements contained in subpart B of part 483 of this 

chapter:

    (1) Residents rights (Sec. 483.10(b)(3) through (b)(6), (d) (e), 

(h), (i), (j)(1)(vii) and (viii), (l), and (m) of this chapter).

    (2) Admission, transfer, and discharge rights (Sec. 483.12(a) of 

this chapter).

    (3) Resident behavior and facility practices (Sec. 483.13 of this 

chapter).

    (4) Patient activities (Sec. 483.15(f) of this chapter), except 

that the services may be directed either by a qualified professional 

meeting the requirements of Sec. 485.15(f)(2), or by an individual on 

the facility staff who is designated as the activities director and who 

serves in consultation with a therapeutic recreation specialist, 

occupational therapist, or other professional with experience or 

education in recreational therapy.

    (5) Social services (Sec. 483.15(g) of this chapter).

    (6) Comprehensive assessment, comprehensive care plan, and discharge 

planning (Sec. 483.20(b), (k), and (l) of this chapter, except that the 

CAH is not required to use the resident assessment instrument (RAI) 

specified by the State that is required under Sec. 483.20(b), or to 

comply with the requirements for frequency, scope, and number of 

assessments prescribed in Sec. 413.343(b) of this chapter).

    (7) Specialized rehabilitative services (Sec. 483.45 of this 

chapter).

    (8) Dental services (Sec. 483.55 of this chapter).

    (9) Nutrition (Sec. 483.25(i) of this chapter).



[63 FR 26359, May 12, 1998 as amended at 64 FR 41544, July 30, 1999; 67 

FR 50120, Aug. 1, 2002; 69 FR 49272, Aug. 11, 2004]