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Washington Highlights

Bipartisan House Legislation Introduced to Delay CMS “Two-Midnight” Rule

December 20, 2013—AAMC President and CEO Darrell G. Kirch, M.D., sent a Dec. 18 support letter  to a bipartisan group of legislators who introduced a bill to delay enforcement of the “two-midnight” rule. The Centers for Medicare and Medicaid Services (CMS) finalized the “two-midnight” rule, which establishes new rules regarding how short hospital stays will be paid under Medicare, as part of the fiscal year (FY) 2014 Medicare inpatient prospective payment system (IPPS) final rule [see Washington Highlights, Aug. 9].

According to the new standard, effective Oct. 1, 2013, hospital stays lasting “two midnights” or longer can continue to be billed as typical Medicare Part A inpatient care. However, the new rule requires, with a few limited exceptions, hospital stays that are shorter than “two midnights” to be categorized as outpatient care and billed under Medicare Part B.

To address concerns with the rule, Reps. Jim Gerlach (R-Pa.), Joe Crowley (D-N.Y.), Ron Kind (D-Wis.), Tom Reed (R-N.Y.), and Peter Roskam (R-Ill.) introduced the Two-Midnight Rule Delay Act of 2013 (H.R. 3698).  The bipartisan legislation would delay enforcement of the Medicare two midnights rule until Oct. 1, 2014, require CMS to develop a new Medicare payment methodology for short inpatient hospital stays, and prevent recovery audit contractors (RACs) from denying claims due to the length of patient stay or due to determination that services could have been provided in an outpatient setting. 

The legislation is similar to language originally included, but ultimately omitted, from the Pathway for SGR Reform Act (H.J. Res 59)[see Washington Highlights, Dec. 13].

CMS Sept. 27 issued additional guidance and delayed enforcement of the “two-midnight” rule for 90 days. That delay has been extended until March 31, 2014.


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Courtney Summers
Senior Legislative Analyst
Telephone: 202-862-6042


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806