,,ii #aacth ,,congress #b;d ,session ,s4 #bjhb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #e1 #bjad,mr4 ,menendez 7for himself and ,mrs4 ,fischer7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide for the development of criteria under the ,medicare program for medically necessary short inpatient hospital stays1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,two-,midnight ,rule ,coordination and ,improvement ,act of #bjad4 #b4 ,development of criteria for medically necessary short inpatient hospital stays 7a7 ,in general 7#a7 ,development of criteria ,the ,secretary shall develop appropriate criteria with regard to the two-midnight rule 7as defined in subsection 7e77 for payment under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for a short inpatient hospital stay 7as defined in such subsection74 7#b7 ,requirements ,the criteria developed under paragraph 7#a7 shall-- 7,a7 account for medical necessity and the appropriateness of an inpatient stay that is less than the two-midnight benchmark2 and 7,b7 subject to paragraph 7#c71 be developed in consultation with interested stakeholders4 7#c7 ,implementation ,the consultation described in paragraph 7#b77;,b7 shall be conducted as part of the annual notice and comment rulemaking process implementing the ,medicare hospital inpatient prospective payment system for fiscal year #bjae4 7b7 ,development of short inpatient hospital stay payment methodology 7#a7 ,in general ,the ,secretary shall develop a payment methodology under the ,medicare program under title ,,xviii of the ,social ,security ,act for hospitals for short inpatient hospital stays4 ,such methodology-- 7,a7 shall be implemented in a budget neutral manner2 7,b7 may be a reduced payment amount for such inpatient hospital services than would otherwise apply if paid for under section #ahhf7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77 or be an alternative payment methodology2 and 7,c7 shall take into consideration the criteria developed under subsection 7a74 7#b7 ,timeframe ,the ,secretary shall promulgate such methodology as part of the annual regulations implementing the ,medicare hospital inpatient prospective payment system for fiscal year #bjae4 7c7 ,crosswalk of ,,icd-#aj codes and ,,cpt codes2 crosswalk of ,,drg and ,,cpt codes 7#a7 ,,icd-#aj-to-,,cpt crosswalk 7,a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall develop general equivalency maps 7referred to in this subsection as crosswalks7 to link the relevant ,,icd-#aj codes to relevant ,,cpt codes1 and the relevant ,,cpt codes to relevant ,,icd-#aj codes1 in order to permit comparisons of inpatient hospital services1 for which payment is made under section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww71 and hospital outpatient department services1 for which payment is made under section #ahcc7t7 of such ,act 7#db ,u4,s4,c4 #aciel7t774 ,in this subsection the terms ,,icd-#aj codes and ,,cpt codes include procedure as well as diagnostic codes4 7,b7 ,process 7i7 ,in general ,in carrying out subparagraph 7,a71 the ,secretary shall develop a proposed ,,icd-#aj-to-,,cpt crosswalk which shall be made available for public comment for a period of not less than #fj days4 7ii7 ,notice ,the ,secretary shall provide notice of the comment period through the following3 7,i7 ,publication of notice of proposed rulemaking in the ,federal ,register4 7,,ii7 ,a solicitation posted on the ,internet ,web site of the ,centers for ,medicare ,medicaid ,services4 7,,iii7 ,an announcement on the ,internet ,web site of the ,centers for ,medicare ,medicaid ,services of the availability of the proposed crosswalk and the deadline for comments4 7,,iv7 ,a broadcast through an appropriate ,listserv operated by the ,centers for ,medicare ,medicaid ,services4 7iii7 ,use of the ,,icd-#i-;,,cm ,coordination and ,maintenance ,committee ,the ,secretary also shall instruct the ,,icd-#i-;,,cm ,coordination and ,maintenance ,committee to convene a meeting to receive input from the public regarding the proposed ,,icd-#aj-to-,,cpt crosswalk4 7iv7 ,publication of final crosswalks ,taking into consideration comments received on the proposed crosswalk1 the ,secretary shall publish a final ,,icd-#aj-to-,,cpt crosswalk under subparagraph 7,a7 and shall post such crosswalk on the ,internet ,web site of the ,centers for ,medicare ,medicaid ,services4 7v7 ,updating ,the ,secretary shall update such crosswalk on an annual basis4 7#b7 ,,drg-to-,,apc crosswalk 7,a7 ,in general ,the ,secretary shall1 using the ,,icd-#aj-to-,,cpt crosswalk developed under paragraph 7#a71 develop a second crosswalk between diagnosis-related group 7,,drg7 codes for inpatient hospital services and ,ambulatory ,payment ,class 7,,apc7 codes for outpatient hospital services4 7,b7 ,data to be used ,in developing such crosswalk1 the ,secretary shall use claims data for inpatient hospital services for discharges occurring in fiscal years beginning with fiscal year #bjae and for outpatient hospital services furnished in years beginning with #bjae4 7,c7 ,publication ,not later than ,june #cj1 #bjag1 the ,secretary shall publish the ,,drg-to-,,apc crosswalk developed under this paragraph4 7d7 ,delay of enforcement of the two-,midnight rule 7#a7 ,in general ,the ,secretary shall not enforce the provisions of the two-midnight rule with respect to admissions to a hospital for which payment is made under the ,medicare program under title ,,xviii of the ,social ,security ,act-- 7,a7 for admissions occurring before ,october #a1 #bjad2 and 7,b7 in the case of admissions occurring on or after ,october #a1 #bjad1 prior to the applicable date 7as defined in paragraph 7#c774 7#b7 ,application to ,medicare review contractors ,paragraph 7#a7 shall also apply to ,medicare review contractors 7as defined in subsection 7e774 ,no ,medicare review contractor may1 based on the provisions of the two-midnight rule1 deny a claim for payment for inpatient hospital services furnished by a hospital1 or inpatient critical access hospital services furnished by a critical access hospital1 for which payment may be made under title ,,xviii of the ,social ,security ,act for discharges occurring before the applicable date 7as defined in paragraph 7#c77-- 7,a7 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 basis2 or 7,b7 for requirements for orders1 certifications1 or recertifications1 and associated documentation relating to the matters described in subparagraph 7,a74 7#c7 ,applicable date defined ,in this subsection1 the term applicable date means the earlier of-- 7,a7 the date on which the criteria described in subsection 7a7 are implemented pursuant to subsection 7a77#c72 or 7,b7 ,october #a1 #bjae4 7#d7 ,continuation of ,medicare ,probe and ,educate program for inpatient hospital admissions 7,a7 ,in general ,subject to subparagraph 7,b71 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 7as defined in subparagraph 7,c77 for hospital admissions during the delay of enforcement under paragraph 7#a74 7,b7 ,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 #d1 #bjac1 such as #aj claims for most hospitals and #be claims for large hospitals4 7,c7 ,medicare ,probe and ,educate program defined ,in this paragraph1 the term ,medicare ,probe and ,educate program means the program established by the ,secretary as in effect on ,november #d1 #bjac 7and described in a public document made available by the ,centers for ,medicare ,medicaid ,services on its ,web site entitled ,frequently ,asked ,questions #b ,midnight ,inpatient ,admission ,guidance ,patient ,status ,reviews for ,admissions on or after ,october #a1 #bjac71 under which ,medicare administrative contractors-- 7i7 conduct prepayment patient status reviews for inpatient hospital claims with dates of admission on or after ,october #a1 #bjac1 and before ,march #ca1 #bjad2 and 7ii7 based on the results of such prepayment patient status reviews1 conduct educational outreach efforts during the following #c months4 7e7 ,definitions ,in this section3 7#a7 ,hospital ,the term hospital means the following 7insofar as such terms are used under title ,,xviii of the ,social ,security ,act73 7,a7 ,an acute care hospital4 7,b7 ,a critical access hospital4 7,c7 ,a long-term care hospital4 7,d7 ,an inpatient psychiatric facility4 7#b7 ,interested stakeholders ,the term interested stakeholders means the following3 7,a7 ,hospitals4 7,b7 ,physicians 7,c7 ,medicare administrative contractors under section #ahgd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a74 7,d7 ,recovery audit contractors under section #ahic7;h7 of such ,act 7#db ,u4,s4,c4 #acie;ddd7h774 7,e7 ,other parties determined appropriate by the ,secretary4 7#c7 ,,ipps ,,fy #bjad ,final ,rule ,the term ,,ipps ,,fy #bjad ,final ,rule means the final rule 7,,cms-#aeii-;,f1 ,,cms-#adee-;,f7 published by the ,centers for ,medicare ,medicaid ,services in the ,federal ,register on ,august #ai1 #bjac1 entitled ,medicare ,program2 ,hospital ,inpatient ,prospective ,payment ,systems for ,acute ,care ,hospitals and the ,long-,term ,care ,hospital ,prospective ,payment ,system and ,fiscal ,year #bjad ,rates2 ,quality ,reporting ,requirements for ,specific ,providers2 ,hospital ,conditions of ,participation2 ,payment ,policies ,related to ,patient ,status 7#gh ,fed4 ,reg4 #ejdif et seq474 7#d7 ,medicare review contractor ,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 ,act1 including-- 7,a7 ,medicare administrative contractors under section #ahgd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a72 and 7,b7 recovery audit contractors under section #ahic7;h7 of such ,act 7#db ,u4,s4,c4 #acie;ddd7h774 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#f7 ,short inpatient hospital stay ,the term short inpatient hospital stay means1 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 hospital1 a length of stay that is less than the length of stay required to satisfy the #b-midnight benchmark described in section #dab4c of title #db1 ,code of ,federal ,regulations1 as amended under the amendment #b referred to in paragraph 7#g77;,a74 7#g7 ,two-midnight rule ,the term two-midnight rule means the following numbered amendments to #db ,,cfr ,chapter ,,iv contained in the ,,ipps ,,fy #bjad ,final ,rule 7and includes any sub-regulatory guidance issued in the implementation of such amendments and any portion of the preamble of section ,,xi4,c4 of such rule relating to such amendments73 7,a7 ,amendment #b 7on page #ejife71 which adds a section #dab4c of title #db1 ,code of ,federal ,regulations 7relating to admissions74 7,b7 ,amendment #c 7on page #ejife71 which revises section #dab4df of such title 7relating to medical review requirements74 7,c7 ,amendment #bc 7on page #ejifi71 which amends paragraphs 7d7 and 7e77#b7 of section #dbd4aa of such title 7relating to conditions of payment3 ,general procedures74 7,d7 ,amendment #bd 7on pages #ejifi and #ejigj71 which revises section #dbd4ac of such title 7relating to requirements for inpatient services of hospitals other than inpatient psychiatric facilities74 7,e7 ,amendment #be 7on page #ejigj71 which revises paragraphs 7a71 7b71 7d77#a71 and 7e7 of section #dbd4ad of such title 7relating to requirements for inpatient services of inpatient psychiatric facilities74 7,f7 ,amendment #bf 7on page #ejigj71 which revises section #dbd4ae of such title 7relating to requirements for inpatient ,,cah services74