Two-Midnight Rule Delay Act of 2013

Summary: Two-Midnight Rule Delay Act of 2013 - Prohibits the Secretary of Health and Human Services (HHS) from enforcing the two-midnight rule to a hospital for which payment is made under title XVIII (Medicare) of the Social Security Act for admissions occurring before October 1, 2014. (The two-midnight rule allows Medicare coverage of only hospital stays for which a physician admits to a hospital a beneficiary expected to require care that crosses two midnights, but generally denies coverage of care expected to require less than a two-midnight stay.) Applies&nbsp;such prohibition to Medicare review contracts.  Prohibits Medicare review contractors from denying a claim for inpartient hospital services furnished by a hospital, or inpatient critical access hospital services furnished by a critical access hospital, for discharges occurring before October 1, 2014: (1) for medical necessity due to the length of an inpatient stay in such hospital or due to a determination that the services could have been provided on an outpatient basis; or (2) for requirements for orders, certifications, or recertifications, and associated documentation relating to such matters. Prohibits the Secretary from increasing the sample of claims selected for prepayment review under the Medicare Probe and Educate program above the number and type established by the Secretary as of November 4, 2013. Directs the Secretary to develop: (1) a Medicare hospital payment methodology for short inpatient hospital stays; (2)&nbsp;general equivalency maps to link the relevant International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes (used to report medical diagnoses and inpatient procedures) to relevant Current Procedural Terminology (CPT) codes, and the relevant CPT codes to relevant ICD-10 codes, in order to permit comparison of inpatient hospital services and hospital outpatient department servives; and (3) a second crosswalk between Diagnosis-Related Group (DRG) codes for inpatient hospital services and Ambulatory Payment Class codes for outpatient hospital services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Two-Midnight Rule Delay Act of 
2013''.

SEC. 2. ENFORCEMENT DELAY OF MEDICARE TWO-MIDNIGHT RULE TO PERMIT 
              DEVELOPMENT OF A NEW MEDICARE PAYMENT METHODOLOGY FOR 
              SHORT INPATIENT HOSPITAL STAYS.

    (a) Delay in Enforcement of Two-Midnight Rule.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary'') shall not 
        enforce the provisions of the two-midnight rule (as defined in 
        paragraph (2)) with respect to admissions to a hospital (as 
        defined in subsection (d)) for which payment is made under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) for admissions occurring before 
        October 1, 2014.
            (2) Two-midnight rule defined.--In this section, the term 
        ``two-midnight rule'' means the following numbered amendments 
        to 42 CFR Chapter IV contained in the IPPS FY 2014 Final Rule 
        (and includes any sub-regulatory guidance issued in the 
        implementation of such amendments and any portion of the 
        preamble of section XI.C. of such rule relating to such 
        amendments):
                    (A) Amendment 2 (on page 50965), which adds a 
                section 412.3 of title 42, Code of Federal Regulations 
                (relating to admissions).
                    (B) Amendment 3 (on page 50965), which revises 
                section 412.46 of such title (relating to medical 
                review requirements).
                    (C) Amendment 23 (on page 50969), which amends 
                paragraphs (d) and (e)(2) of section 424.11 of such 
                title (relating to conditions of payment: General 
                procedures).
                    (D) Amendment 24 (on pages 50969 and 50970), which 
                revises section 424.13 of such title (relating to 
                requirements for inpatient services of hospitals other 
                than inpatient psychiatric facilities).
                    (E) Amendment 25 (on page 50970), which revises 
                paragraphs (a), (b), (d)(1), and (e) of section 424.14 
                of such title (relating to requirements for inpatient 
                services of inpatient psychiatric facilities).
                    (F) Amendment 26 (on page 50970), which revises 
                section 424.15 of such title (relating to requirements 
                for inpatient CAH services).
            (3) IPPS fy 2014 final rule defined.--In this section, the 
        term ``IPPS FY 2014 Final Rule'' means the final rule (CMS-
        1599-F, CMS-1455-F) published by the Centers for Medicare & 
        Medicaid Services in the Federal Register on August 19, 2013, 
        entitled ``Medicare Program; Hospital Inpatient Prospective 
        Payment Systems for Acute Care Hospitals and the Long-Term Care 
        Hospital Prospective Payment System and Fiscal Year 2014 Rates; 
        Quality Reporting Requirements for Specific Providers; Hospital 
        Conditions of Participation; Payment Policies Related to 
        Patient Status'' (78 Federal Register 50496 et seq.).
            (4) Application to medicare review contractors.--
                    (A) In general.--Paragraph (1) shall also apply to 
                Medicare review contractors (as defined in subparagraph 
                (B)). No Medicare review contractor may deny a claim 
                for payment for inpatient hospital services furnished 
                by a hospital, or inpatient critical access hospital 
                services furnished by a critical access hospital, for 
                which payment may be made under title XVIII of the 
                Social Security Act for discharges occurring before the 
                date specified in paragraph (1)--
                            (i) for medical necessity due to the length 
                        of an inpatient stay in such hospital or due to 
                        a determination that the services could have 
                        been provided on an outpatient basis; or
                            (ii) for requirements for orders, 
                        certifications, or recertifications, and 
                        associated documentation relating to the 
                        matters described in clause (i).
                    (B) Medicare review contractor defined.--In 
                subparagraph (A), the term ``Medicare review 
                contractor'' means any contractor or entity that has 
                entered into a contract or subcontract with the Centers 
                for Medicare & Medicaid Services with respect to the 
                Medicare program to review claims for items and 
                services furnished for which payment is made under 
                title XVIII of the Social Security Act, including--
                            (i) Medicare administrative contractors 
                        under section 1874A of the Social Security Act 
                        (42 U.S.C. 1395kk-1); and
                            (ii) recovery audit contractors under 
                        section 1893(h) of such Act (42 U.S.C. 
                        1395ddd(h)).
            (5) Continuation of medicare probe and educate program for 
        inpatient hospital admissions.--
                    (A) In general.--Subject to subparagraph (B), 
                nothing in this subsection shall be construed to 
                preclude the Secretary from continuing the conduct by 
                Medicare administrative contractors of the Medicare 
                Probe and Educate program (as defined in subparagraph 
                (C)) for hospital admissions during the delay of 
                enforcement under paragraph (1).
                    (B) Maintenance of sample prepayment record 
                limits.--The Secretary may not increase the sample of 
                claims selected for prepayment review under the 
                Medicare Probe and Educate program above the number and 
                type established by the Secretary under such program as 
                of November 4, 2013, such as 10 claims for most 
                hospitals and 25 claims for large hospitals.
                    (C) Medicare probe and educate program defined.--In 
                this paragraph, the term ``Medicare Probe and Educate 
                program'' means the program established by the 
                Secretary as in effect on November 4, 2013 (and 
                described in a public document made available by the 
                Centers for Medicare & Medicaid Services on its Website 
                entitled ``Frequently Asked Questions 2 Midnight 
                Inpatient Admission Guidance & Patient Status Reviews 
                for Admissions on or after October 1, 2013'') under 
                which Medicare administrative contractors--
                            (i) conduct prepayment patient status 
                        reviews for inpatient hospital claims with 
                        dates of admission on or after October 1, 2013, 
                        and before March 31, 2014; and
                            (ii) based on the results of such 
                        prepayment patient status reviews, conduct 
                        educational outreach efforts during the 
                        following 3 months.
    (b) Short Inpatient Hospital Stay Payment Methodology.--
            (1) In general.--The Secretary shall develop a payment 
        methodology under the Medicare program for hospitals for short 
        inpatient hospital stays (as defined in paragraph (2)). Such 
        payment methodology may be a reduced payment amount for such 
        inpatient hospital services than would otherwise apply if paid 
        for under section 1886(d) of the Social Security Act (42 U.S.C. 
        1395ww(d)) or may be an alternative payment methodology. The 
        Secretary shall promulgate such payment methodology as part of 
        the annual regulations implementing the Medicare hospital 
        inpatient prospective payment system for fiscal year 2015.
            (2) Short inpatient hospital stay defined.--In this 
        section. the term ``short inpatient hospital stay'' means, with 
        respect to an inpatient admission of an individual entitled to 
        benefits under part A of title XVIII of the Social Security Act 
        to a hospital, a length of stay that is less than the length of 
        stay required to satisfy the 2-midnight benchmark described in 
        section 412.3 of title 42, Code of Federal Regulation, as 
        amended under the Amendment 2 referred to in subsection 
        (a)(2)(A).
    (c) Crosswalk of ICD-10 Codes and CPT Codes; Crosswalk of DRG and 
CPT Codes.--
            (1) ICD10-to-CPT crosswalk.--
                    (A) In general.--Not later than 2 years after the 
                date of the enactment of this Act, the Secretary shall 
                develop general equivalency maps (referred to in this 
                subsection as ``crosswalks'') to link the relevant ICD-
                10 codes to relevant CPT codes, and the relevant CPT 
                codes to relevant ICD-10 codes, in order to permit 
                comparisons of inpatient hospital services, for which 
                payment is made under section 1886 of the Social 
                Security Act (42 U.S.C. 1395ww), and hospital 
                outpatient department services, for which payment is 
                made under section 1833(t) of such Act (42 U.S.C. 
                1395l(t)). In this subsection the terms ``ICD-10 
                codes'' and ``CPT codes'' include procedure as well as 
                diagnostic codes.
                    (B) Process.--
                            (i) In general.--In carrying out 
                        subparagraph (A), the Secretary shall develop a 
                        proposed ICD10-to-CPT crosswalk which shall be 
                        made available for public comment for a period 
                        of not less than 60 days.
                            (ii) Notice.--The Secretary shall provide 
                        notice of the comment period through the 
                        following:
                                    (I) Publication of notice of 
                                proposed rulemaking in the Federal 
                                Register.
                                    (II) A solicitation posted on the 
                                Internet Website of the Centers for 
                                Medicare & Medicaid Services.
                                    (III) An announcement on the 
                                Internet Website of the Centers for 
                                Medicare & Medicaid Services of the 
                                availability of the proposed crosswalk 
                                and the deadline for comments.
                                    (IV) A broadcast through an 
                                appropriate Listserv operated by the 
                                Centers for Medicare & Medicaid 
                                Services.
                            (iii) Use of the icd-9-cm coordination and 
                        maintenance committee.--The Secretary also 
                        shall instruct the ICD-9-CM Coordination and 
                        Maintenance Committee to convene a meeting to 
                        receive input from the public regarding the 
                        proposed ICD10-to-CPT crosswalk.
                            (iv) Publication of final crosswalks.--
                        Taking into consideration comments received on 
                        the proposed crosswalk, the Secretary shall 
                        publish a final ICD10-to-CPT crosswalk under 
                        subparagraph (A) and shall post such crosswalk 
                        on the Internet Website of the Centers for 
                        Medicare & Medicaid Services.
                            (v) Updating.--The Secretary shall update 
                        such crosswalk on an annual basis.
            (2) DRG-to-APC crosswalk.--
                    (A) In general.--The Secretary shall, using the 
                ICD10-to-CPT crosswalk developed under paragraph (1), 
                develop a second crosswalk between diagnosis-related 
                group (DRG) codes for inpatient hospital services and 
                Ambulatory Payment Class (APC) codes for outpatient 
                hospital services.
                    (B) Data to be used.--In developing such crosswalk, 
                the Secretary shall use claims data for inpatient 
                hospital services for discharges occurring in fiscal 
                years beginning with fiscal year 2015 and for 
                outpatient hospital services furnished in years 
                beginning with 2015.
                    (C) Publication.--Not later than June 30, 2017, the 
                Secretary shall publish the DRG-to-APC crosswalk 
                developed under this paragraph.
    (d) Hospital Defined.--For purposes of this section, the term 
``hospital'' means the following (insofar as such terms are used under 
title XVIII of the Social Security Act):
            (1) An acute care hospital.
            (2) A critical access hospital.
            (3) A long-term care hospital.
            (4) An inpatient psychiatric facility.