,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #cfih  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aa1         
#bjac,mr4 ,g]la* 7= himself1 ,mr4       
,cr[ley1 ,mr4 ,re$1 ,mr4 ,roskam1 & ,mr4
 ,k9d7 introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,ways & ,means
  ,a ,,bill  ,to delay ! en=cem5t ( !   
,m$ic>e two-midnight rule = %ort        
inpati5t hospital /ays until !          
implem5tation ( a new ,m$ic>e paym5t    
me?odology = %ort inpati5t hospital     
/ays1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z !              
,two-,midnight ,rule ,delay ,act (      
#bjac4  #b4 ,en=cem5t delay ( ,m$ic>e   
two-midnight rule to p]mit developm5t ( 
a new ,m$ic>e paym5t me?odology = %ort  
inpati5t hospital /ays  7a7 ,delay 9    
en=cem5t ( two-,midnight rule  7#a7 ,9  
g5]al ,! ,secret>y ( ,heal? & ,human    
,s]vices 7ref]r$ to 9 ?is section z !   
,secret>y7 %all n en=ce ! provisions ( !
 two-midnight rule 7z def9$ 9 p>agraph  
7#b77 ) respect to admissions to a      

hospital 7z def9$ 9 subsection 7d77 =   
:i* paym5t is made "u ! ,m$ic>e program 
"u title ,,xviii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq47 =    
admissions occurr+ be=e ,octob] #a1     
#bjad4  7#b7 ,two-midnight rule def9$ ,9
 ?is section1 ! t]m two-midnight rule   
means ! foll[+ numb]$ am5dm5ts to #db   
,,cfr ,*apt] ,,iv conta9$ 9 ! ,,ipps    
,,fy #bjad ,f9al ,rule 7& includes any  
sub-regulatory guidance issu$ 9 !       
implem5tation ( su* am5dm5ts & any      
portion ( ! preamble ( section ,,xi4,c4 
( su* rule relat+ to su* am5dm5ts73 7,a7
 ,am5dm5t #b 7on page #ejife71 :i* adds 
a section #dab4c ( title #db1 ,code (   
,f$]al ,regulations 7relat+ to          
admissions74  7,b7 ,am5dm5t #c 7on page 
#ejife71 :i* revises section #dab4df (  
su* title 7relat+ to m$ical review      
requirem5ts74  7,c7 ,am5dm5t #bc 7on    
page #ejifi71 :i* am5ds p>agraphs 7d7 & 
7e77#b7 ( section #dbd4aa ( su* title   
7relat+ to conditions ( paym5t3 ,g5]al  
proc$ures74  7,d7 ,am5dm5t #bd 7on pages

 #ejifi & #ejigj71 :i* revises section  
#dbd4ac ( su* title 7relat+ to          
requirem5ts = inpati5t s]vices (        
hospitals o!r ?an inpati5t psy*iatric   
facilities74  7,e7 ,am5dm5t #be 7on page
 #ejigj71 :i* revises p>agraphs 7a71    
7b71 7d77#a71 & 7e7 ( section #dbd4ad ( 
su* title 7relat+ to requirem5ts =      
inpati5t s]vices ( inpati5t psy*iatric  
facilities74  7,f7 ,am5dm5t #bf 7on page
 #ejigj71 :i* revises section #dbd4ae ( 
su* title 7relat+ to requirem5ts =      
inpati5t ,,cah s]vices74  7#c7 ,,ipps   
,,fy #bjad ,f9al ,rule def9$ ,9 ?is     
section1 ! t]m ,,ipps ,,fy #bjad ,f9al  
,rule means ! f9al rule                 
7,,cms-#aeii-;,f1 ,,cms-#adee-;,f7      
publi%$ by ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices 9 ! ,f$]al ,regi/] on ,augu/   
#ai1 #bjac1 entitl$ ,m$ic>e ,program2   
,hospital ,inpati5t ,prospective ,paym5t
 ,sy/ems = ,acute ,c>e ,hospitals & !   
,long-,t]m ,c>e ,hospital ,prospective  
,paym5t ,sy/em & ,fiscal ,ye> #bjad     
,rates2 ,quality ,report+ ,requirem5ts =

 ,specific ,provid]s2 ,hospital         
,conditions ( ,p>ticipation2 ,paym5t    
,policies ,relat$ to ,pati5t ,/atus 7#gh
 ,f$]al ,regi/] #ejdif et seq474  7#d7  
,application to ,m$ic>e review          
contractors  7,a7 ,9 g5]al ,p>agraph    
7#a7 %all also apply to ,m$ic>e review  
contractors 7z def9$ 9 subp>agraph      
7,b774 ,no ,m$ic>e review contractor may
 d5y a claim = paym5t = inpati5t        
hospital s]vices furni%$ by a hospital1 
or inpati5t critical access hospital    
s]vices furni%$ by a critical access    
hospital1 = :i* paym5t may be made "u   
title ,,xviii ( ! ,social ,security ,act
 = dis*>ges occurr+ be=e ! date specifi$
 9 p>agraph 7#a7-- 7i7 = m$ical         
necessity due to ! l5g? ( an inpati5t   
/ay 9 su* hospital or due to a          
det]m9ation t ! s]vices c\ld h be5      
provid$ on an outpati5t basis2 or  7ii7 
= requirem5ts = ord]s1 c]tifications1 or
 rec]tifications1 & associat$           
docum5tation relat+ to ! matt]s describ$
 9 clause 7i74  7,b7 ,m$ic>e review     

contractor def9$ ,9 subp>agraph 7,a71 ! 
t]m ,m$ic>e review contractor means any 
contractor or entity t has ent]$ into a 
contract or subcontract ) ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices ) respect to 
! ,m$ic>e program to review claims =    
items & s]vices furni%$ = :i* paym5t is 
made "u title ,,xviii ( ! ,social       
,security ,act1 includ+-- 7i7 ,m$ic>e   
adm9i/rative contractors "u section     
#ahgd;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciekk-#a72 &  7ii7 recov]y 
audit contractors "u section #ahic7;h7 (
 su* ,act 7#db ,u4,s4,c4 #acie;ddd7h774 
7#e7 ,cont9uation ( ,m$ic>e ,probe &    
,educate program = inpati5t hospital    
admissions  7,a7 ,9 g5]al ,subject to   
subp>agraph 7,b71 no?+ 9 ?is subsection 
%all be con/ru$ to preclude ! ,secret>y 
f cont9u+ ! conduct by ,m$ic>e          
adm9i/rative contractors ( ! ,m$ic>e    
,probe & ,educate program 7z def9$ 9    
subp>agraph 7,c77 = hospital admissions 
dur+ ! delay ( en=cem5t "u p>agraph     
7#a74  7,b7 ,ma9t5ance ( sample         

prepaym5t record limits ,! ,secret>y may
 n increase ! sample ( claims select$ = 
prepaym5t review "u ! ,m$ic>e ,probe &  
,educate program above ! numb] & type   
e/abli%$ by ! ,secret>y "u su* program z
 ( ,novemb] #d1 #bjac1 su* z #aj claims 
= mo/ hospitals & #be claims = l>ge     
hospitals4  7,c7 ,m$ic>e ,probe &       
,educate program def9$ ,9 ?is p>agraph1 
! t]m ,m$ic>e ,probe & ,educate program 
means ! program e/abli%$ by ! ,secret>y 
z 9 effect on ,novemb] #d1 #bjac 7&     
describ$ 9 a public docum5t made        
available by ! ,c5t]s = ,m$ic>e         
,m$icaid ,s]vices on its ,website       
entitl$ ,frequ5tly ,ask$ ,que/ions #b   
,midnight ,inpati5t ,admission ,guidance
  ,pati5t ,/atus ,reviews = ,admissions 
on or aft] ,octob] #a1 #bjac7 "u :i*    
,m$ic>e adm9i/rative contractors-- 7i7  
conduct prepaym5t pati5t /atus reviews =
 inpati5t hospital claims ) dates (     
admission on or aft] ,octob] #a1 #bjac1 
& be=e ,m>* #ca1 #bjad2 &  7ii7 bas$ on 
! results ( su* prepaym5t pati5t /atus  

reviews1 conduct educational outrea*    
ef=ts dur+ ! foll[+ #c mon?s4  7b7 ,%ort
 inpati5t hospital /ay paym5t me?odology
  7#a7 ,9 g5]al ,! ,secret>y %all       
develop a paym5t me?odology "u ! ,m$ic>e
 program = hospitals = %ort inpati5t    
hospital /ays 7z def9$ 9 p>agraph 7#b774
 ,su* paym5t me?odology may be a r$uc$  
paym5t am\nt = su* inpati5t hospital    
s]vices ?an w\ld o!rwise apply if paid =
 "u section #ahhf7;d7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77 or may be an alt]native     
paym5t me?odology4 ,! ,secret>y %all    
promulgate su* paym5t me?odology z "p ( 
! annual regulations implem5t+ ! ,m$ic>e
 hospital inpati5t prospective paym5t   
sy/em = fiscal ye> #bjae4  7#b7 ,%ort   
inpati5t hospital /ay def9$ ,9 ?is      
section4 ! t]m %ort inpati5t hospital   
/ay means1 ) respect to an inpati5t     
admission ( an individual entitl$ to    
b5efits "u "p ,a ( title ,,xviii ( !    
,social ,security ,act to a hospital1 a 
l5g? ( /ay t is less ?an ! l5g? ( /ay   

requir$ to satisfy ! #b-midnight b5*m>k 
describ$ 9 section #dab4c ( title #db1  
,code ( ,f$]al ,regulation1 z am5d$ "u !
 ,am5dm5t #b ref]r$ to 9 subsection     
7a77#b77;,a74  7c7 ,crosswalk (         
,,icd-#aj codes & ,,cpt codes2 crosswalk
 ( ,,drg & ,,cpt codes  7#a7            
,,icd#aj-to-,,cpt crosswalk  7,a7 ,9    
g5]al ,n lat] ?an #b ye>s aft] ! date ( 
! enactm5t ( ?is ,act1 ! ,secret>y %all 
develop g5]al equival5cy maps 7ref]r$ to
 9 ?is subsection z crosswalks7 to l9k !
 relevant ,,icd-#aj codes to relevant   
,,cpt codes1 & ! relevant ,,cpt codes to
 relevant ,,icd-#aj codes1 9 ord] to    
p]mit comp>isons ( inpati5t hospital    
s]vices1 = :i* paym5t is made "u section
 #ahhf ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acieww71 & hospital outpati5t
 dep>tm5t s]vices1 = :i* paym5t is made 
"u section #ahcc7t7 ( su* ,act 7#db     
,u4,s4,c4 #aciel7t774 ,9 ?is subsection 
! t]ms ,,icd-#aj codes & ,,cpt codes    
include proc$ure z well z diagno/ic     
codes4  7,b7 ,process  7i7 ,9 g5]al ,9  

c>ry+ out subp>agraph 7,a71 ! ,secret>y 
%all develop a propos$ ,,icd#aj-to-,,cpt
 crosswalk :i* %all be made available = 
public comm5t = a p]iod ( n less ?an #fj
 days4  7ii7 ,notice ,! ,secret>y %all  
provide notice ( ! comm5t p]iod ?r\gh ! 
foll[+3 7,i7 ,publication ( notice (    
propos$ rulemak+ 9 ! ,f$]al ,regi/]4    
7,,ii7 ,a solicitation po/$ on !        
,int]net ,website ( ! ,c5t]s = ,m$ic>e  
,m$icaid ,s]vices4  7,,iii7 ,an         
ann\ncem5t on ! ,int]net ,website ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices ( ! 
availability ( ! propos$ crosswalk & !  
deadl9e = comm5ts4  7,,iv7 ,a broadca/  
?r\gh an appropriate ,li/s]v op]at$ by !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4   
7iii7 ,use ( ! ,,icd-#i-;,,cm           
,coord9ation & ,ma9t5ance ,committee ,! 
,secret>y also %all in/ruct !           
,,icd-#i-;,,cm ,coord9ation & ,ma9t5ance
 ,committee to conv5e a meet+ to receive
 input f ! public reg>d+ ! propos$      
,,icd#aj-to-,,cpt crosswalk4  7iv7      
,publication ( f9al crosswalks ,tak+    

into consid]ation comm5ts receiv$ on !  
propos$ crosswalk1 ! ,secret>y %all     
publi% a f9al ,,icd#aj-to-,,cpt         
crosswalk "u subp>agraph 7,a7 & %all po/
 su* crosswalk on ! ,int]net ,website ( 
! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4  
7v7 ,updat+ ,! ,secret>y %all update su*
 crosswalk on an annual basis4  7#b7    
,,drg-to-,,apc crosswalk  7,a7 ,9 g5]al 
,! ,secret>y %all1 us+ !                
,,icd#aj-to-,,cpt crosswalk develop$ "u 
p>agraph 7#a71 develop a second         
crosswalk betwe5 diagnosis-relat$ gr\p  
7,,drg7 codes = inpati5t hospital       
s]vices & ,ambulatory ,paym5t ,class    
7,,apc7 codes = outpati5t hospital      
s]vices4  7,b7 ,data to be us$ ,9       
develop+ su* crosswalk1 ! ,secret>y %all
 use claims data = inpati5t hospital    
s]vices = dis*>ges occurr+ 9 fiscal ye>s
 beg9n+ ) fiscal ye> #bjae & = outpati5t
 hospital s]vices furni%$ 9 ye>s beg9n+ 
) #bjae4  7,c7 ,publication ,n lat] ?an 
,june #cj1 #bjag1 ! ,secret>y %all      
publi% ! ,,drg-to-,,apc crosswalk       

develop$ "u ?is p>agraph4  7d7 ,hospital
 def9$ ,= purposes ( ?is section1 ! t]m 
hospital means ! foll[+ 7ins(> z su*    
t]ms are us$ "u title ,,xviii ( !       
,social ,security ,act73 7#a7 ,an acute 
c>e hospital4  7#b7 ,a critical access  
hospital4  7#c7 ,a long-t]m c>e         
hospital4  7#d7 ,an inpati5t psy*iatric 
facility4