Section 28-11 - Medicaid Allowable Payment for Swing-bed Services (a) The per diem rate for swing-bed services shall be the lesser of: - (i) The hospital's usual and customary charges for swing-bed services; or
- (ii) The lowest per diem rate currently in effect for nursing facility services furnished in a nursing facility in the community where the hospital is located, as determined pursuant to Chapter 7, Nursing Home Reimbursement System.
(b) The per diem rate includes reimbursement for all services and supplies furnished to the client, including all services and supplies included in the per diem rates established pursuant to Chapter 7, Nursing Home Reimbursement System, (including Attachment A), except as otherwise specified in this Chapter.
(c) A hospital shall not be reimbursed for swing-bed services if: - (i) The client was admitted to the hospital from a nursing facility which has available an appropriate bed to which the client could return;
- (ii) There is an available bed in a nursing facility within the hospital's geographic region, as defined in 42 C.F.R. § 413.114(b), and the client has not been transferred as required by Section 13.
- (A) "Available bed." A certified bed in a nursing facility that is:
- (I) Not occupied by an individual;
- (II) Not a reserved bed for which the facility has received or will receive reimbursement; and
- (III) In a nursing facility willing and able to provide the services required by the client.
- (iii) The hospital is located outside the State of Wyoming; or
- (iv) As otherwise prohibited by 42 C.F.R. § 413.114(d).
(d) The facility shall maintain records of the costs it incurs in furnishing swing-bed services. Costs related to swing-bed services shall not be cost settled by Medicaid and shall not be used to rebase inpatient hospital rates pursuant to Chapter 30.
048-28 Wyo. Code R. § 28-11