House members ask HHS to clarify enforcement plans for 96-hour rule

A bipartisan group of 25 House members yesterday asked Health and Human Services Secretary Xavier Becerra to clarify by Sept. 9 whether and how the Administration plans to enforce Medicare’s 96-hour payment rule and condition of participation for critical access hospitals after the COVID-19 public health emergency.

The rule requires CAHs to certify inpatients will be discharged or transferred to another hospital within 96 hours of admission to receive payment. A related Medicare condition of participation requires CAH inpatient stays to remain below 96 hours on an annual average basis. HHS has not prioritized enforcement of the rule since 2018 due to its financial burden on hospitals and waived the condition of participation in response to the COVID-19 public health emergency.

“Even after the PHE formally ends, COVID and other respiratory diseases are likely to cause some patients to need hospitalizations lasting longer than 96 hours,” the representatives wrote (LINK). “These and other patients who can safely and effectively be treated in their local hospital deserve the option of receiving care closer to their homes, families, and usual doctors.”