Action needed on swing bed proposal

November 29, 2017

The House Ways and Means Committee recently announced a bipartisan agreement to extend certain expiring Medicare provisions. The proposal would extend the Medicare low-volume adjustment program and Medicare dependent hospital status for two years, and extend add-on payments for rural ground ambulance and home health services for five years.

The proposal also includes a number of possible Medicare payment changes to offset the cost of the extensions, including cuts in Medicare swing bed, skilled nursing facility and home health payments.

There has been a lot of speculation about what the committee plans for CAH payments. So far, the committee has not provided any details about the proposed cuts, nor is there any legislative language available to review.

The Senate Finance Committee has outlined its bipartisan package of Medicare extenders, which would also extend the rural ambulance and home health add-ons for five years. The Senate version does not propose a cut to swing beds in Critical Access Hospitals.

Action needed

The Medicare extenders package could move quickly as Congress hurries to wrap up its work for the year. Please urge your representative to support extending expiring Medicare programs but to reject any effort to cut Medicare payments to CAHs to offset the cost of these extensions. Please send these messages to the health legislative assistant, local district staff if you have a relationship, and the chief of staff. Click here for WSHA’s directory with the names/emails of these staff people.
Specifically emphasize:

  • The impact in your facility of the rural ambulance and rural home health payment add-ons and share that with your member of Congress.
  • The impact of loss of Medicare swing bed payments on your organization’s financial viability. The Office of the Inspector General is recommending that swing beds be paid at the same rate as a skilled nursing facility. The average skilled nursing home rate in the state for Medicaid is about $220 a day.

Talking Points

  • I am writing today to express significant concerns about the House’s Ways and Means proposal contained in the “Medicare extenders” draft to cut payments to swing beds in Critical Access Hospitals (CAHs).
  • If funding is cut to swing beds, many CAHs like mine, will be forced to close these units. Patients will be forced to be transferred to another facility, sometimes over long distances, for intensive follow up care after a hospitalization.
  • CAHs are the cornerstone of our state’s rural health network, providing access to health care services for thousands of seniors who live in small communities across our state. In the absence of these facilities, seniors often would have to drive significant distances to obtain medical treatment.
  • Declining rural populations, aging – and sicker – patients, a persistent shortage of health care professionals and increasing regulatory burdens threaten access to care in these areas. The Medicare rural payment add-ons were enacted in recognition of the special challenges facing providers in rural areas.
  • This is a time when Congress should be looking for ways to ensure access and stabilize the rural health network – rather than cutting payments for critical health care services in our most vulnerable rural communities.
  • Please reject proposals to cut Medicare payments to our state’s Critical Access Hospitals.


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