Enforcement Again Delayed on “Two Midnight” Hospital Rule

CMS has delayed enforcement and penalties related to its new and controversial “two midnight rule. ” The deadline to begin enforcement of the rule had already been delayed from Oct. 1, 2013, to March 31, 2014 and is now being pushed back to September 30, 2014.

The final hospital rule, published last August, modifies and clarifies CMS’s longstanding admissions policy for payment purposes. The 2-midnight benchmark states that if the admitting practitioner admits a Medicare beneficiary as an inpatient with the reasonable expectation that the beneficiary will require care that “crosses 2 midnights,” Medicare Part A payment is “generally appropriate,” assuming medical record documentation justifies the admission.

The attempt to clarify admission rules was in part driven by beneficiary complaints about increased use, and length of, observation stays, which left some patients who went to nursing homes subject to surprise 20% copayments.

The AHA and the AMA have been lobbying strongly for a repeal or delay of the the new rule.  AHA questions CMS’s assertion that the new rule will bring in more revenue as hospitals will be able to bill full inpatient rates on cases that may have been outpatient in the past.

AHA has threatened litigation around the issue.

Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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