CMS Finalizes Significant Changes to the Two Midnight Rule in the 2016 OPPS Final Rule

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On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2016 Outpatient Prospective Payment System Final Rule (2016 OPPS Final Rule). In the 2016 OPPS Final Rule, CMS finalizes significant changes to the Two Midnight Rule that were first proposed this summer.

Beginning January 1, 2016, CMS will allow Part A coverage of one-day stays in certain limited circumstances under standards similar to the pre-Two Midnight Rule standards for evaluating patient status. Although the scope of this exception is unclear at this point, CMS notes that it would “continue to expect that stays under 24 hours would rarely qualify for an exception” to the Two Midnight Benchmark.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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