Feb. 26—New legislation would block a long-unenforced Medicare discharge requirement for critical access hospitals (CAHs) amid signs that regulators will begin enforcing it.  

The legislation was introduced this week to block Medicare’s requirement that physicians in CAHs  certify that they expect to discharge or transfer a patient within 96 hours. The Centers for Medicare & Medicaid Services has long left the requirement unenforced, but guidance related to new admissions policies implied that 96-hour enforcement could start.

Legislation to block the requirement, the Critical Access Hospital Relief Act of 2014, was sponsored by Sen. Pat Roberts (R-Kan.) and is a companion measure to a House bill introduced last month. The legislation is needed, Roberts said in a release, to address concerns that the 96-hour rule does not account for changes in the patient’s condition after admission that could require longer stays.

”This is likely to lead to premature discharges and readmissions, both of which CMS has taken actions to minimize,” Roberts said. “In some cases rural patients may be forced to travel to an urban hospital a great distance away.”

The Senate legislation already has drawn 13 rural state cosponsors.

The legislation would not eliminate the Medicare requirement that CAHs maintain an average annual length of stay of 96 hours or change other hospital certification requirements.

More than 1,300 CAHs must meet a range of specific requirements—including providing 24-hour emergency care services seven days a week—to receive higher reimbursements from Medicare.

The 96-hour rule enforcement is the latest cost savings measure to target CAHs. Last year, the Office of Inspector General recommended reducing the number of hospitals designated as CAHs.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Wednesday, February 26, 2014