Ala. Admin. Code r. 560-X-46-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-46-.04 - Level Of Care

(1) In order to receive swing bed services recipients must require SNF level of care on a daily basis. The skilled services provided must be ones that, on a practical basis, can only be provided on an inpatient basis.

(2) A condition that does not ordinarily require skilled care may require this care because of a special medical condition. Under such circumstances the service may be considered skilled because it must be performed by or supervised by skilled nursing or rehabilitation personnel.

(3) The restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. A patient may need skilled services to prevent further deterioration or preserve current capabilities.

(4) Swing bed admissions not covered by Medicare because they do not meet medical criteria shall also be considered noncovered by Medicaid. Therefore, these services cannot be reimbursed as a straight Medicaid service.

Author: Vicki Huff

Ala. Admin. Code r. 560-X-46-.04

Emergency rule effective March 30, 1989. Permanent rule effective July 13, 1989.

Statutory Authority: Title XIX, Social Security Act; State Plan, Attachment 3.1-A, 4.19-B; 42 CFR §§409.30, 409.31, 409.32, 456.600.