Senate Two-Midnight Rule Bill Would Require New Payment Guidelines

Sens. Robert Menendez (D-N.J.) and Deb Fischer (D-Neb.) have introduced the Two-Midnight Rule Coordination and Improvement Act, which would establish new guidelines for CMS' creation of criteria payment methodologies concerning short inpatient hospital stays.

According to a news release from Rep. Menendez, the current two-midnight regulation is "rigid" and "could lead to instances where a physician is unable to make the proper medical determination for a beneficiary’s treatment." In addition to the new guidelines, the bill would also codify enforcement delays CMS has already announced for the two-midnight rule.

The two-midnight rule was established by the 2014 Medicare inpatient prospective payment rule. According to the policy, 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 introduced the policy to better monitor Medicare reimbursement for short inpatient stays and ensure inpatient admissions are medically necessary.

Hospital leaders have fiercely opposed the rule, saying it is unclear and undermines the medical judgment of physicians. The American Hospital Association has expressed concerns about the rule and support for the newly proposed bill.

"The current CMS policy is bad news for seniors because it undermines the medical judgment of physicians," AHA Executive Vice President Rick Pollack said in a news release. "The bill also rightly calls on the agency to develop an acceptable long-term payment solution."

More Articles on the Two-Midnight Rule:
CMS Posts Guidance on Two-Midnight Policy, Audits  
7 Statistics on the Clinical Impact of the Two-Midnight Rule  
CMS Delays Two-Midnight Rule 

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