April 14 -- In two related lawsuits filed April 14, the
hospital industry challenged the Department of Health and Human Services'
“two-midnight” rule for inpatient admissions, which industry says imposes
regulatory burdens that could compromise care for seniors.
one complaint filed in the U.S. District Court for the
District of Columbia, the American Hospital Association and other industry
groups and individual hospitals challenged an August 2013 HHS policy for
determining when a patient is an “inpatient” for purposes of Medicare
The AHA's filing said that this “new rule provides that a
Medicare beneficiary is not an 'inpatient' unless the admitting physician
expects that beneficiary to need care in the hospital for a period spanning two
midnights.” The August 2013 rule was for fiscal year 2014 payments .
statement from the AHA, the plaintiffs said hospitals “take issue with the
wholly arbitrary requirement that a physician must certify at the time of
admission that a Medicare patient is expected to need care in the hospital for a
period spanning two midnights to be considered an inpatient.” In the statement,
Rich Umbdenstock, president and chief executive officer of the AHA, said that
the two-midnight rule “undermines medical judgment and disregards the level of
care needed to safely treat patients.” He added, “Hospitals stand by a
physician's decision on what care is appropriate for each patient. The
two-midnight rule is misguided and we feel confident the court will agree.”
A separate complaint filed April 14 takes aim at a payment cut that
plaintiffs said “will cost the nation's hospitals more than $200 million this
year alone” (Am. Hosp. Ass'n v. Sebelius, D.D.C., No. 1:14-cv-00607 ,
“Using the new two-midnights rule as a fig
leaf,” the Centers for Medicare & Medicaid Services “decided to cut the
payments hospitals receive for treating Medicare patients,” the complaint
The complaint said that CMS claimed, “without setting forth its
actuaries' reasoning or calculations--that the two-midnights rule and other
related policy changes would result in a net increase in the number of inpatient
hospital stays that Medicare covers under Part A.” Specifically, the CMS reduced
payments by 0.2 percent across the board for beneficiary discharges occurring on
or after Oct. 1, 2013, the complaint said.
The AHA said it is joined in
the litigation by the Greater New York Hospital Association, the Healthcare
Association of New York State, New Jersey Hospital Association and the Hospital
& Healthcare Association of Pennsylvania. Individual hospital plaintiffs are
Wake Forest University Baptist Medical Center, North Carolina; the Mount Sinai
Hospital, New York City; hospitals that are part of Phoenix-based Banner Health;
and Einstein Healthcare Network, Philadelphia.
Attorneys representing the
AHA include Sheree R. Kanner and Dominic F. Perella, of Hogan Lovells US LLP in
Washington, and Melinda Reid Hatton of the AHA in Washington.
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