Feb 3.—The Centers for Medicare & Medicaid Services (CMS) delayed for an additional six months enforcement of its new Medicare hospital admissions policy.

In a notice posted on the CMS website recently, the agency announced that Medicare administrative contractors (MACs) will continue to “probe and educate” acute care hospitals, long term care hospitals (LTCHs) and inpatient psychiatric facilities (IPFs) on the so-called two-midnight rule.

The two-midnight rule established new inpatient hospital admission requirements under Medicare Part A that required each physician to document that they expect the beneficiary to require a stay of at least two midnights and admit the patient based on that expectation.

The new admissions requirements, which were laid out by the FY14 IPPS final rule issued in August 2013, were originally supposed to go into effect Oct. 1, 2013 but they were delayed in the fall until April 1.

The latest delay, until Oct. 1, 2014, will keep recovery audit contractors (RACs) from conducting pre-payment patient status reviews of admissions that began after September 2013. However, RACs may continue to conduct CMS-approved claim reviews that are unrelated to inpatient admission decisions.

Additionally, CMS will not conduct post-payment patient status reviews of admissions starting October 1, 2013, through October 1, 2014.

CMS specified that it will conduct prepayment patient status probe reviews of admissions beginning Oct. 1, 2013, during the delay. Also unaffected by the delay are other types of inpatient reviews by MACs, RACs and supplemental medical review contractors, such whether inpatient hospital admissions before October 2013 met the previous admission requirements. RAC s also will continue reviews of less-than two midnight stays.

The CMS also will hold a conference call Feb. 4 to discuss details of the two-midnight policy with providers.

Delay’s Effects

The delay was welcomed by hospital advocates.

“This action clearly recognizes that there are still many unanswered questions about the policy,” Rick Pollack, executive vice president for the American Hospital Association, said in a written statement. “At the same time, we continue to urge CMS to fix the critical flaws of the underlying policy by immediately engaging stakeholders to find a workable solution that addresses the reasonable and necessary inpatient-level services currently provided by hospitals to Medicare beneficiaries that are not expected to span two midnights.”

The CMS delay followed the recent introduction of legislation to delay the two-midnight reviews until October 2014, as well as a push for a judicial review on the policy.

The enforcement delay will not include suspension of a 0.2 percent cut in FY14 IPPS standardized payment amounts, according to a CMS official. Those reductions were implemented to reflect anticipated savings of the two-midnight policy change.

Publication Date: Monday, February 03, 2014