In an increasingly difficult regulatory environment for rural health providers, the U.S. Office of Inspector General has recommended a cut to one of rural health’s few remaining lifelines. The OIG's recent recommendation takes aim at “swing bed” services offered by Critical Access Hospitals, proposing that reimbursements for such services be significantly reduced. 

Swing bed services allow certified Critical Access Hospitals to use their beds to furnish either acute or post-acute Skilled Nursing Facility-level care. Critical Access Hospitals are reimbursed for these services at 101 percent of the reasonable cost of the services — a common adjustment afforded to such hospitals. 

The report recommends that Critical Access Hospitals be reimbursed for swing bed services under the regular payment system for SNF-level services, both as a cost-saving measure for Medicare and because many such services are being offered within 35 miles of adequate, alternative SNF care (effectively defeating the purpose of the special CAH reimbursement). 

The OIG’s report does not address the possible ramifications of the proposed cut on the viability of Critical Access Hospitals. The recommendation still must be implemented by CMS before it becomes law.