Two-Midnight Rule Delay Act of 2013

To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. 1. Short title This Act may be cited as the Two-Midnight Rule Delay Act of 2013 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 42 U.S.C. 1395 et seq. (2) Two-midnight rule defined In this section, the term two-midnight rule (A) Amendment 2 (on page 50965), which adds a section 412.3 (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 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 (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 (i) Medicare administrative contractors under section 1874A of the Social Security Act ( 42 U.S.C. 1395kk–1 (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 Frequently Asked Questions 2 Midnight Inpatient Admission Guidance & Patient Status Reviews for Admissions on or after October 1, 2013 (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) (2) Short inpatient hospital stay defined In this section. the term short inpatient hospital stay section 412.3 (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 42 U.S.C. 1395ww 42 U.S.C. 1395l(t) ICD–10 codes CPT 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 (1) An acute care hospital. (2) A critical access hospital. (3) A long-term care hospital. (4) An inpatient psychiatric facility.

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 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) 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.