Reps. Adrian Smith (R-Neb.), Greg Walden (R-Ore.), Lynn Jenkins (R-Kan.) and David Loebsack (D-Iowa) have introduced legislation that would eliminate the 96-hour physician certification requirement for payment of inpatient critical access hospital services.
The Critical Access Hospital Relief Act of 2014 would change a Medicare regulation under which physicians must certify that patients admitted to CAHs will be discharged or transferred to another hospital within 96 hours in order for the hospital to receive Medicare reimbursement for the patient's treatment.
Although CMS has historically enforced this regulation, the agency's guidance on the two-midnight rule suggests that will change, according to an AHA News report. The American Hospital Association has said the requirement could threaten patients' access to care by prohibiting longer stays when needed.
The two-midnight rule was included in the 2014 Medicare inpatient prospective payment rule. The regulation states that inpatient admissions spanning at least two midnights qualify for Medicare Part A payments. Inpatient stays lasting fewer than two midnights must be treated and billed as outpatient services. CMS recently delayed the two-midnight rule through Sept. 30 following vehement opposition from hospitals and other healthcare groups.
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