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Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003

Changes in Medicare reimbursement policy that began with the Balanced Budget Act of 1997 resulted in differential reimbursement for care in swing beds and skilled nursing facilities.  This final report looks at whether the availability of post-acute skilled care stabilized once these changes were implemented and how and where this care is being provided today.

Key findings include:

  • Options for post-acute skilled care are available for many rural residents, but availability and choice are limited for some residents residing in the most rural areas.
  • The swing bed program represents a small proportion of all post-acute skilled care in rural areas but may be important for access for certain populations.
  • Access to hospital-based Skilled Nursing Facilities (SNFs) has declined in rural areas.
  • Swing bed participation and total swing bed days have grown.
  • The proportion of CAHs with swing beds has not changed.  The contribution of swing beds to CAH average daily census has increased modestly and only in the most rural areas.
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