SEC. 2. ENFORCEMENT DELAY OF MEDICARE TWO-MID-
NIGHT 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 fol-
lowing 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 por-
tion of the preamble of section XI.C. of such rule re-
lating to such amendments): 
(A) Amendment 2 (on page 50965), which 
adds a section 412.3 of title 42, Code of Fed-
eral Regulations (relating to admissions). 
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(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 sec-
tion 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 psy-
chiatric 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 (relat-
ing to requirements for inpatient CAH serv-
ices). 
(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 
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Services in the Federal Register on August 19, 
2013, entitled ‘‘Medicare Program; Hospital Inpa-
tient Prospective Payment Systems for Acute Care 
Hospitals and the Long-Term Care Hospital Pro-
spective Payment System and Fiscal Year 2014 
Rates; Quality Reporting Requirements for Specific 
Providers; Hospital Conditions of Participation; Pay-
ment Policies Related to Patient Status’’ (78 Fed-
eral Register 50496 et seq.). 
(4) APPLICATION TO MEDICARE REVIEW CON-
TRACTORS.— 
(A) IN
GENERAL.—Paragraph (1) shall 
also apply to Medicare review contractors (as 
defined in subparagraph (B)). No Medicare re-
view 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 
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could have been provided on an outpatient 
basis; or 
(ii) for requirements for orders, cer-
tifications, or recertifications, and associ-
ated documentation relating to the matters 
described in clause (i). 
(B) MEDICARE REVIEW CONTRACTOR DE-
FINED.—In subparagraph (A), the term ‘‘Medi-
care 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, includ-
ing— 
(i) Medicare administrative contrac-
tors under section 1874A of the Social Se-
curity 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 AD-
MISSIONS.— 
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(A) IN
GENERAL.—Subject to subpara-
graph (B), nothing in this subsection shall be 
construed to preclude the Secretary from con-
tinuing 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 enforce-
ment under paragraph (1). 
(B) MAINTENANCE
OF
SAMPLE
PREPAY-
MENT RECORD LIMITS.—The Secretary may not 
increase the sample of claims selected for pre-
payment review under the Medicare Probe and 
Educate program above the number and type 
established by the Secretary under such pro-
gram as of November 4, 2013, such as 10 
claims for most hospitals and 25 claims for 
large hospitals. 
(C) MEDICARE PROBE AND EDUCATE PRO-
GRAM 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 Cen-
ters for Medicare & Medicaid Services on its 
Website entitled ‘‘Frequently Asked Questions 2 
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Midnight Inpatient Admission Guidance & Pa-
tient Status Reviews for Admissions on or after 
October 1, 2013’’) under which Medicare ad-
ministrative 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 pre-
payment patient status reviews, conduct 
educational outreach efforts during the fol-
lowing 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 method-
ology 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 
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hospital inpatient prospective payment system for 
fiscal year 2015. 
(2) SHORT
INPATIENT
HOSPITAL
STAY
DE-
FINED.—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 ‘‘cross-
walks’’) 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 serv-
ices, for which payment is made under section 
1886 of the Social Security Act (42 U.S.C. 
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1395ww), and hospital outpatient department 
services, for which payment is made under sec-
tion 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 de-
velop 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 pro-
posed rulemaking in the Federal Reg-
ister. 
(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 
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availability of the proposed crosswalk 
and the deadline for comments. 
(IV) A broadcast through an ap-
propriate Listserv operated by the 
Centers for Medicare & Medicaid 
Services. 
(iii) USE OF THE ICD–9–CM COORDI-
NATION 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 pro-
posed ICD10–to–CPT crosswalk. 
(iv) PUBLICATION OF FINAL CROSS-
WALKS.—Taking into consideration com-
ments 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 Inter-
net 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.— 
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(A) IN
GENERAL.—The Secretary shall, 
using the ICD10–to–CPT crosswalk developed 
under paragraph (1), develop a second cross-
walk between diagnosis-related group (DRG) 
codes for inpatient hospital services and Ambu-
latory Payment Class (APC) codes for out-
patient hospital services. 
(B) DATA
TO
BE
USED.—In developing 
such crosswalk, the Secretary shall use claims 
data for inpatient hospital services for dis-
charges 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 para-
graph. 
(d) HOSPITAL DEFINED.—For purposes of this sec-
tion, the term ‘‘hospital’’ means the following (insofar as 
such terms are used under title XVIII of the Social Secu-
rity Act): 
(1) An acute care hospital. 
(2) A critical access hospital. 
(3) A long-term care hospital. 
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(4) An inpatient psychiatric facility. 
Æ 
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