Some in the provider community has been grumbling about CMS' decision behind the rulemaking for the two-midnight rule. What is interesting is that this action was taken in response to providers asking for relief from the arbitrary actions of the RAC. Be careful what you ask for, the devil you know may be better than the one you don’t.
January 22, 2014
The AHA, several hospital associations (Greater New York, New York State, New Jersey and Pennsylvania) and four hospital systems today took the first steps to bring a federal court challenge to the Centers for Medicare & Medicaid Services’ two-midnight inpatient admissions criteria and related policies. Taking that initial action, hospitals that are part of Banner Health (AZ), Einstein Healthcare Network (PA) and Wake Forest University Baptist Medical Center (NC) and The Mount Sinai Hospital (NY) filed appeals asking the Provider Reimbursement Review Board to grant expedited judicial review for the hospitals’ claims that the rule’s 0.2% payment cut for Fiscal Year 2014 inpatient prospective payment system hospitals is unlawful. “The Providers seek judicial review of pure questions of law regarding the substantive and procedural validity of the 0.2% reduction,” the hospitals’ appeals state. “Because the [PRRB] lacks the power to grant the Providers’ requested relief, it should grant expedited judicial review.” The hospitals contend that the reduced inpatient payment they receive under the final rule is arbitrary and capricious because CMS relied on indefensible assumptions and offered no reasoned explanation for them. They also argue that the payment cut fails to comply with Administrative Procedure Act’s requirements for proper notice and comment and was not codified in regulation as the law requires.
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