While a similar bill has already been introduced in the House, on Wednesday Senators Robert Menendez, D-N.J. and Deb Fischer, R-Neb. put forth The Two-Midnight Rule Coordination and Improvement Act of 2014 to address the hospital observation stay vs. inpatient issue and revise CMS's impending "two-midnight rule," reports McKnight's Long-Term Care News.
Less than a month ago, RehabCare Advantage reported that when hospitals keep patients in observation status rather than admit them as inpatients, it can result in lack of Medicare coverage for follow-up skilled nursing care and leave patients with out-of-pocket expenses.
CMS responded to the issue in 2013 with a reduced requirement - the two-midnight rule - which establishes that Medicare beneficiaries receive inpatient status for a hospital stay lasting two or more midnights. The two-midnight rule was set to take effect on Oct. 1, 2013 but has been delayed several times - now to Sept. 30 of this year.
Some lawmakers and physicians allege that the two-midnight rule does not do enough to alleviate the problem and wish to delay the rule further. In a joint statement published on Health Data Management, Senators Menendez and Fischer stated that "While this approach addresses some longstanding issues for beneficiaries requiring longer hospital stays, it fails to acknowledge instances where it is medically necessary for a beneficiary to receive inpatient services for a period spanning less than two midnights. The rigid approach currently taken by this rule could lead to instances where a physician is unable to make the proper medical determination for a beneficiary's treatment."
The Senate bill would require the HHS secretary to consult with stakeholders to determine criteria for inpatient stays that do not last midnights. The bill also codifies the delay of the two-midnight rule enforcement.
The American Hospital Association and Association of American Medical Colleges have voiced their support for the bill, reports Modern Healthcare.
RehabCare will continue to provide updates as the situation develops.
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