Swing Bed Basics for Critical Access Hospitals


Available Now – Self Paced and On-Demand




Section 1861(e) of the Social Security Act allows certain small, rural hospitals and critical access hospitals (CAHs) approved to provide swing bed services to use their beds for acute care or post-hospital skilled nursing facility (SNF) care. These rural hospitals and CAHs increase Medicare patient access to post-acute SNF care.


According to the 2020 CMS interpretive guidelines for swing beds in Critical Access Hospitals (CAHs), a ‘swing-bed’ is a change in reimbursement status.  As a payment model, a CAH can use its beds interchangeably for either acute care or post-acute care. The reimbursement “swings” from billing for acute care services to billing for post-acute skilled nursing services, even though the patient usually stays in the same bed in the same physical location.


The course will focus on elements of a successful Swing Bed program including understanding and implementing CMS regulatory requirements found in the State Operations Manual Appendix W, State Operations Manual Appendix PP, and Medicare Benefit Policy Manuals including Chapter 8.

Who Should Attend:

The course is designed for anyone responsible for overseeing, coordinating, or participating in a Swing Bed program, or anyone wanting to increase their knowledge about Swing Bed.   Recommended participants include Chief Nursing Officers, Swing Bed Coordinators, Case Managers, Discharge Planners, Social Workers, Physical Therapists, Occupational Therapists, Speech Therapists, Dieticians, Dietary Managers, and Pharmacists.

Delivery Format:

The course is divided into six (6) modules.  Each module may take up to two (2) weeks to complete, including learning assignments.


Education will be provided in a virtual environment using a combination of pre-recorded didactic presentations, discussion threads, and a virtual meeting space with monthly discussions.


Module 1 – Swing Bed History and Regulatory Requirements
– Swing Bed resources
– Swing Bed value
– History of Swing Bed
– Number of beds
– Reimbursement
– Sources of regulatory requirements
– Overview of Appendix W, Appendix PP, and Medicare Benefits Manual Chapter 8

Module 2 – Swing Bed Criteria and Pre-admission

– Choice of post-acute providers
– Medicare admission criteria for Swing Bed
– Examples of skilled care
– Pre-Admission processes
– Choice of post-acute care providers

Module 3 – Admission Process

– Patient disclosures
– Initial assessment
– Baseline plan of care

Module 4 – Multi-Disciplinary Plan of Care

– Developing the multi-disciplinary plan of care
– Structuring effective care plan meetings

Module 5 – Continuing Care

– Reassessment after significant change
– Abuse, neglect, exploitation and misappropriation of property
– Nutrition
– Dental
– Medication Management
– Activities
– Rehabilitation
– Social Service

Module 6 – Discharge

– Choice of Post-Acute Care Provider
– Discharge Patient Rights
– Discharge Information to next provider of care
– Ombudsman Notice of Discharge
– Discharge Planning Processes
– Preventing Readmissions


At the completion of this course, the participant will be able to:
– Understand where to find regulatory requirements for Swing Bed
– Understand the differences between Appendix W and Appendix PP
– Explain Medicare requirements for admission to Swing Bed
– Explain the difference between Medicare requirements for admission to swing bed and other payors
– Discuss elements of patient choice of post-acute care provider
– Identify elements of admission assessment
– Explain timeframe for completion of admission assessment after admission
– Identify required elements of the multi-disciplinary plan of care
– Discuss at least two ways to conduct effective multi-disciplinary care plan meetings
– Explain the importance and ways of monitoring patients’ nutritional status
– Identify at least two ways in which nursing and rehab staff can work together to improve the patient’s functional status
– Explain required discharge notices and timeframes for delivering
– Discuss process for notifying ombudsman of discharge

Continuing Education Credit Calculations:

Module 1: Objectives 01-02/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Module 2: Objectives 03-05/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Module 3: Objectives 06-07/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Module 4: Objectives 08-09/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Module 5: Objectives 10-11/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Module 6: Objectives 12-13/Recommend 2 wks. per module/Asynchronous Discussion & Clinical Practice (3 Hours); Recorded Lecture (30 Minutes)/1.5 hrs.

Total:  9 hrs

Continuing Education Credit Information:

HealthTech Management Services D/B/A HealthTech is a Provider approved by the California Board of Registered Nursing. Provider Number CEP8769 for 9.0 contact hours. Participant must complete all course work – no partial credit will be given. A certificate of completion will be provided by HealthTech within 30 days of successful completion of the course.

Refund / Cancellation Policy:

Cancellations received in writing prior to the start of the course will be refunded, less $50.00 administrative expense. Registration fees may be transferred to another individual prior to the start of the educational offering.  Individuals who enroll in an online educational course and who open any module content will not be eligible for refunds.


Carolyn St. Charles, MBA, BSN, RN

HealthTech, Chief Clinical Officer

Carolyn St. Charles has more than 30 years’ experience in healthcare, including more than 15 years in senior leadership positions.  St. Charles works collaboratively with senior leaders, providers and clinical staff to develop and implement sustainable strategies for improving both financial and clinical outcomes.  She provides education and consulting for Swing Bed programs thru-out the United States.

St. Charles earned an Associate Degree in Nursing from Pima Community College in Tucson, Arizona, a Bachelor of Science in Nursing from Northern Arizona University and a Master of Business Administration from the University of Washington Foster School of Business. She is a member of the American Organization of Nurse Executives, Case Management Society of America and Phi Kappa Phi.


Cheri Benander, RN MSN, CHC, C-NHCE

HealthTech Clinical & Compliance Consultant

Cheri has over 30 years’ experience in various healthcare roles to include clinical, management, administration, compliance, consulting, and education. Her leadership experience has extended to multiple healthcare settings to include acute care, home health, hospice, assisted living and long-term care. As a consultant, Ms. Benander has worked collaboratively with leaders and clinical staff to improve productivity, time management, and leadership skills, formulate survey responses, and implement various programs including compliance.

She received her undergraduate nursing education from Fort Scott Community College and her bachelor’s and master’s degrees in nursing from the University of Phoenix. She is a Certified Healthcare Compliance (CHC) professional through the Health Care Compliance Association (HCCA) and received a graduate certification in Nursing and Healthcare Education from the University of Phoenix. Benander is a registered nurse and a member of the American Nurses Association (ANA) , the American Organization of Nursing Leadership (AONL), and the Health Care Compliance Association (HCCA).


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