Joint Commission Swing Bed Requirements
The Social Security Act permits certain small, rural hospitals to enter into “swing bed” agreements, under which the hospital can use its beds, as needed, to provide either acute or Skilled Nursing Facility (SNF) care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Swing beds are often used when a patient is ready to leave acute care level hospital care but is not yet well enough to return home.
Swing beds are regulated under Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs). In October 2016, CMS revised their CoPs with the final rule, “Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities”. This final rule was effective at the end of November 2016 and revised CoPs for swing beds in hospitals and critical access hospitals, at 482.58 and 485.645 respectively. Due to technical errors, CMS published a corrected final rule in 2017.
In response to the CMS final rule, The Joint Commission has made several changes to their swing bed requirements, effective January 13, 2018. Critical Access Hospitals and Hospitals using Joint Commission accreditation for deemed status purposes that have swing beds are now being surveyed under these new requirements.
Highlights of the changes include:
- Assessments are coordinated with the preadmission screening and resident review (PASARR). (PC.01.02.01) [Hospitals]
- Incorporation of any specialized rehabilitation services into the treatment plan as a result of PASARR recommendations. [Critical Access Hospitals)
- A policy must be developed and implemented that outlines when loss/damage to dentures is the hospital's responsibility and thus the resident may not be charged for replacement. Further the hospital must refer a resident with lost/damaged dentures to dental services within three days. If the referral is not done within three days, the hospital must document what was done to make sure the resident is able to adequately eat/drink as well as noting extenuating circumstances that lead to the delay. (PC.02.02.01) [Hospitals and Critical Access Hospitals]
- The organization must send a copy of the written transfer/discharge notice to the office of the state’s long-term care ombudsman. (PC.04.01.03) [Hospitals and Critical Access Hospitals]
- Alleged violations related to abuse and neglect are reported within two (2) hours of allegation in instances of abuse or serious bodily injury and within twenty-four (24) of allegation if not involving abuse or serious bodily injury. (RI.01.06.03) [Hospitals and Critical Access Hospitals]
- The organization must notify, in writing, residents and required agencies of closure prior to the impending closure. [Critical Access Hospitals]
- Critical Access Hospitals must focus on patient-centered care with involvement of the resident in care planning. [Critical Access Hospitals]
Included with today’s notice are example policies related to the new TJC requirements.
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