Chapter 46 — Swing Beds
Customize your policy alerts
Sign up for all Alabama Medicaid policy alerts
Know when Alabama Medicaid releases new policies or updates existing guidance.
Monitor payer policy activity
Governs Alabama Medicaid participation, enrollment, reimbursement, level-of-care, services, billing, admission review, and patient agreements for hospital swing bed programs; applies to hospitals seeking or holding swing bed approval under Alabama Medicaid.
No material clinical or coverage changes in this revision.
Coverage criteria for swing bed services
Coverage criteria for swing bed services
Covered when ALL of the following are met:
Covered services include
- Nursing care provided by or under the supervision of a registered nurse.
- Bed and board in a semi-private room (private accommodations allowable only when medically required or semi-private rooms unavailable).
- Over-the-counter drugs routinely used in patient care (e.g., acetaminophen, aspirin, antacids, antidiarrheals, stool softeners).
- Personal services and facility supplies ordinarily furnished for patient comfort and cleanliness.
- Nursing and treatment supplies as ordered by the physician (examples: needles, syringes, catheters, drainage bags, dressings, IV administration sets, common IV fluids).
Reimbursement, billing, and rate references
| Per diem reimbursement at the average rate per patient day paid by Medicaid to SNF/ICF combination facilities for routine services furnished during the previous calendar year; no year-end cost settlement. |
Enrollment, agreements, admissions, and utilization review
Submit enrollment packet and sign provider agreement
Providers wishing to enroll must submit a written request to Medicaid and include proof of current hospital licensure (if not already on file), proof of current Medicare swing bed certification (if not already on file), and proof of a certificate of need (CON) if not on file. Each request is reviewed for completeness and accuracy prior to approval; approved providers will be issued a provider agreement that must be signed and returned to Medicaid within 30 days of the date mailed. Provider agreements are valid for no more than 12 calendar months, and the effective date of enrollment cannot be earlier than the date of the enrollment application.
- Submit written enrollment request to Medicaid
- Include: current hospital licensure, Medicare swing bed certification, and CON (if not on file)
- Provider agreement mailed upon approval — sign and return within 30 days
- Provider agreements valid ≤ 12 calendar months
- Effective enrollment date cannot precede application date
Obtain admission review and perform required recertifications
Admission for Medicaid-covered swing bed care requires review by the Medicaid Medical and Quality Review Unit (or its designee) to verify necessity and that a physician certified the need for swing bed care on the date of admission using Form 199; the Unit (or designee) will certify level of care and may issue medical approvals. Continued-stay recertifications are required at 30, 60, and 90 days after admission and then every 60 days thereafter, with the physician stating “I certify” and specifying the patient requires skilled care. The admission packet (fully completed Form 199 with physician-certified documentation) must be sent to the Medical and Quality Review Unit or designee within 60 days from the date Medicaid coverage is sought.
- Medical and Quality Review Unit (or designee) performs admission review and certifies level of care using Form 199
- If not approved, a Medical Director will review and approve/deny eligibility
- Admission packet (completed Form 199 and supporting physician-certified documentation) must be submitted within 60 days
- Continued-stay recertifications: 30, 60, 90 days after admission, then every 60 days; physician must state “I certify” and specify need for skilled care
- A 3-day qualifying acute hospital stay is required prior to swing bed admission for reimbursement and must be within the same period of illness
Key definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.