Senators Introduce Bill to Remove 96-hour Certification Requirement for CAHs

Efforts to remove a pre-admission requirement designed to shorten Medicare patient stays at more expensive critical access hospitals (CAHs) got a boost as a bi-partisan companion bill was introduced to advance a legislative fix in the Senate alongside efforts in the House.

Senators Pat Roberts (R-Kan.) and Jon Tester (D-Mont.) introduced a Senate companion (S. 2037) to the House’s “Critical Access Hospital Relief Act” (H.R. 3991), which would end the current requirement that a physician must certify that a Medicare patient will be either discharged or transferred to a non-CAH facility within 96 hours before that patient can be admitted. Without this certification, the CAH that admits the patient can be denied payment under Medicare Part A.

The American Hospital Association (AHA) noted that the Centers for Medicare & Medicaid Services (CMS) has not historically enforced the requirement. However, it may start doing so along with enforcing the two-midnight policy that seeks to curb the use of observation stays for Medicare patients.

The AHA was already backing the bi-partisan H.R. 3991, which was introduced in February by Representatives Adrian Smith (R-N.E.), Greg Walden (R-Ore.), Lynn Jenkins (R-Kan.) and David Loebsack (D-Iowa). In a letter to Senator Roberts, it also declared its support for the Senate companion bill.

According to the AHA, the legislation is needed because making physicians certify that a patient must be discharged or transferred within 96 hours could threaten patients’ access to longer care when needed and harm the financial viability of CAHs. Removing the certification requirement also would be unlikely to significantly raise Medicare costs because CAHs would still be required to maintain an average length of stay of 96 hours for patients and be subject to all of the other certification requirements for hospitals.

The bill was referred to the Senate Finance committee, and has little chance of being passed into law by itself. The legislative tracking site GovTrack.us gave it a 0 percent chance of being enacted.

However, it and the House bill could be incorporated into another bill if it is able to gain enough powerful co-sponsors. Currently it has 15 co-sponsors, including Senators Tammy Baldwin (D-Wis.), John Brasso (R-Wyo.), Susan Collins (R-Maine), Richard Durbin (D-Ill.), Michael Enzi (R-Wyo.), Deb Fischer (R-N.E.), Al Franken (D-Minn.), Charles Grassley (R-Iowa), John Hoeven (R-N.D.), James Inhofe (R-Okla.), Mike Johanns (R-N.E.), Mark Kirk (R-Ill.), Amy Klobuchar (D-Minn.) and Jerry Moran (R-Kan.).