Relaxing the 96-hour Rule for Rural Hospitals Could Protect Funding

March 13, 2014

Rural hospitals and their patients are particularly vulnerable to loss of funding. This small rule change could make a significant impact.

Congress often provides exceptions or nuances for rural hospitals and providers on related major laws. Recently, bi-partisan Members of Congress introduced a bill (H. R. 3991 – Critical Access Hospital Relief Act of 2014), which would exempt physicians' compliance with the Medicare rule requiring certification "that a patient is expected to be discharged or transferred to a different hospital in less than 96 hours" in order to be reimbursed. As the preamble to the bill states, the purpose is "[t]o amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access service hospitals."

The text of the bill is short: it seeks to amend Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) in three areas. Specifically, three amendments are required:

• "in paragraph (6), by adding "and" at the end;

• in paragraph (7), at the end of subparagraph (D)(ii), by striking "and" and inserting a period; and

• by striking paragraph (8).

These three subtle, yet substantial changes would apply to "items and services furnished on or after January 1, 2014." Thereby, making the application retroactive.

For rural physicians and hospitals alike, whose funding is critical to citizens residing in these areas because it enables access to emergency care and services, close attention should be paid to the status of this bill. With the multitude of changes in the healthcare landscape, including the "two-midnight rule," providers should be cognizant of the impact these small but significant changes can have on reimbursement and compliance obligations.