SNF Regulations in a CAH
From what we are finding, some of the regulations specific to swing-beds in CAHs seem a little gray so we are hoping for clarification on these two questions:
- Are mid-level providers allowed to admit patients to a skilled level of care (swing-bed) in a CAH (providing they are being supervised and notes are being co-signed by a physician)?
- Is an H&P required for swing-bed admits and what is the time frame for completing the service? Does the 30-day window for nursing home physician certification apply or are we bound by our own bylaws since the patient is admitted to a CAH? (or is there another answer?)
Sign In to comment.
Comments
I would use the SNF regulations. Swing beds are SNF beds. start on oage 456 of this document
A physician’s personal approval of an admission recommendation must be in written form. The written recommendation for admission to the facility must be provided by a physician and cannot be provided by a NPP.
Thank you @RHirsch
In a SNF, the first physician visit (this includes the initial comprehensive visit) must be conducted within the first 30 days after admission, but in a CAH an admission H&P is required within 24 hours patient is admitted. Would you use the SNF regulations and guidance for this as well?
Well, honestly, there are regulations and there is common sense. Most SNFs are free standing facilites that doctors visit once a month. But Swing beds are in your facility, the doctor is there so they should see them sooner. Heck, they should see them the day after they get admitted. They know the paitent and it's an easy visit. So encourage it the next day or soon thereafter but it's not the rule--that's 30 days.
A nice reference for swing beds- https://icahn.org/wp-content/uploads/2018/10/2020-Swing-Bed-Manual.pdf