Wyo. Code R. 048-0037-28
Medicaid
Chapter 28: Payment for Swing Bed Services
Effective Date: 10/15/2025 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0037.28.10152025
Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter under the Medical Assistance and Services Act, Wyoming Statute §§ 42-4-101 through 124.
Section 2. Purpose and Applicability. This Chapter governs the provision of and payment for swing bed services.
(a) Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1 or as otherwise defined in this Chapter, the terminology used herein has the standard meaning used in healthcare, Medicaid, and Medicare.
(b) “Chapter” refers to the specified chapter in the Wyoming Department of Health, Medicaid Rules.
Section 4. General Provision. Medicaid reimbursement for swing bed services and services provided to extraordinary care clients is limited to services furnished to individuals that are nursing facility eligible.
Section 5. Hospital Participation. A hospital that wishes to receive Medicaid payment for swing bed services furnished to a client must meet the requirements of applicable federal regulations, including 42 C.F.R. § 482.58 and 483.1 through 483.95.
(a) The MDS requirements for nursing facility services required by 42 C.F.R. § 483.20 also apply to swing bed services. Each hospital must comply with the MDS requirements for nursing facility services.
(b) The MDS must be completed on or before the day specified by HHS regulations.
Section 7. Determination of Medical Eligibility. Each applicant and client must undergo an evaluation of medical necessity pursuant to Chapter 22 before a hospital may receive Medicaid payment for swing bed services provided to that individual.
(a) The per diem rate for swing bed services is the lesser of:
furnished in a nursing facility in the community where the hospital is located, as determined pursuant to Chapter 7.
(b) The per diem rate includes payment for all services and supplies furnished to a client except as otherwise specified in this Chapter.
(c) A hospital will not be paid 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 payment; 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 must maintain records of the costs it incurs in furnishing swing bed services. Costs related to swing bed services must not be cost settled by Medicaid and must not be used to rebase inpatient hospital rates pursuant to Chapter 30.
(a) Except as provided in subsection (c) an applicant or client receiving swing bed services must be transferred to the first available, appropriate nursing facility bed in the hospital's geographic region upon the availability date, as defined in 42 C.F.R. § 413.114(b). Medicaid payment to the hospital for swing bed services will terminate after the date of the transfer.
(b) The facility must maintain records of its efforts to transfer each client, including the facility or facilities contacted and any response. Such records must be maintained as part of the client's medical records kept pursuant to Chapter 3.
(c) The requirements of subsection (a) do not apply if the client's physician certifies, in writing, that transfer is not medically appropriate.
Section 10. Payment of Claims. Each claim must contain a certification by the hospital that the service was medically necessary, that it was provided on the date specified, that third party liability has been paid or, if third party liability has been denied, documentation of that denial is attached, and that the payment sought is not in excess of the hospital's usual and customary charge for the service.
Section 11. Inpatient Services. Medicaid will not pay for inpatient services furnished to an extraordinary care client unless the client is discharged from the swing bed and admitted to a hospital as an inpatient.
(a) Reserve bed days.
(i) Medicaid will not pay for reserve bed days.
(ii) A hospital must not bill a client or the client's family for reserved bed days that are not paid pursuant to this section unless the nursing facility has informed the client in writing before the period for which payment is sought of the client's option to make payments to hold the bed.
(a) For any code, standard, rule or regulation incorporated by reference in these rules:
(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of these rules;
(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and
(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.
(b) Each rule incorporated by reference is further identified as follows:
(i) Referenced in Section 5 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. G, Pt. 482, Subpart D, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.
(ii) Referenced in Section 5 and 9 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. G, Pt. 483, Subpart B, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.
(iii) Referenced in Section 11 and 13 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. B, Pt. 413, Subpart F, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.