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7. Complete a manual DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability or the split PML to each facility. Include the ending date of split PML on the DHB-5016.

8. NC FAST sends a separate DHB-5016 reporting the PML amount and effective date for the ongoing (next) month.

X. HOSPITAL LEVEL OF CARE CHANGE AND DECERTIFIED FACILITY PROCEDURES

A. Hospital Inappropriate Level Of Care Bed Or Swing Bed

(Refer to Table A for reimbursement rates.)

There are two types of hospital beds for LTC care. These are: (1) inappropriate level of care bed; and (2) swing bed. Sometimes when patient is ready to be discharged to ltc, there is no available ltc bed. A hospital may continue to provide care for patients who are approved for LTC, pending discharge to a facility. This care is provided in an inappropriate level of care bed or swing bed.

1. All hospitals have inappropriate level of care beds. When level of care changes from acute to skilled nursing:

a. A hospital has three (3) administrative days (starting with the day after the day the level of care changes), in which to move the patient to a Medicaid nursing facility. During these three days, the hospital may continue to bill at the acute level.

b. On the 4th day after the level of care changes, the hospital must bill at the inappropriate level of care if it has not been able to move the patient to a nursing facility.

2. Swing beds are hospital beds that have been certified as nursing home level beds. Not all hospitals have swing beds. A swing bed must be certified as such by Medicare.

a. The hospital must begin billing at the swing bed level of care rate the day after the level of care changes.

b. If the hospital has no swing beds or if all swing beds are occupied, they must bill at the inappropriate level of care rate after the three day administrative period. (see X.A.2., above)

3. Impact on Month of Institutionalization

If the patient moves from a general hospital stay of less than 30 days directly to an inappropriate level of care bed or a swing bed, the patient became institutionalized on the first day of the hospital admission. (See II.A.l.b., above)

4. Prior Approval for Inappropriate Level Bed and Swing Bed Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493