CCA and National Coalition on Health Care Joint Letter on CMS “Two Midnights” Requirement

October 31, 2013
Jonathan Blum
Deputy Administrator, Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, D.C. 20201

RE: FY2014 Medicare Inpatient Prospective Payment System (IPPS) Final Rule – Anticipated CMS Guidance on “Two Midnights”

Dear Deputy Administrator Blum:

On September 26th, the Centers for Medicare & Medicaid Services (CMS) held a Special Open Door Forum during which CMS stated that the Agency was planning to issue detailed subregulatory guidance to clarify the FY2014 Medicare Inpatient Prospective Payment System (IPPS) Final Rule’s “Two Midnights” requirement. CMS specifically stated that such guidance would address that hospital utilization review programs and conditions of participation are not changing with implementation of the Final Rule. CMS also confirmed that the IPPS Final Rule, “should not be used as a reason for hospitals to abandon their use of critical medical necessity and coverage assessments,” in public statements made by the CMS Philadelphia Regional Office. We agree that the “Two Midnights” requirement should not be interpreted as a substitute for sound clinical judgment based on objective, evidence-based medicine.

To assist CMS in issuing needed clarifying language, attached please find proposed language for inclusion in the forthcoming subregulatory guidance that CMS is currently preparing. We appreciate your continued efforts to clarify these important details regarding “Two Midnights” in order to minimize confusion and ensure beneficiaries are receiving appropriate care at the appropriate time. Thank you.


John Rother, President & CEO, National Coalition on Health Care

Frederic S. Goldstein, Executive Director, Care Continuum Alliance

Read the Letter

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