Officials laud bill to repeal 96-hour rule

WASHINGTON — A rule requiring small rural hospitals like McCook’s to transfer Medicare patients after 96 hours hasn’t been enforced during the pandemic, and officials are lauding a bipartisan bill to repeal it permanently, Republican Rep. Adrian Smith of Nebraska and Democrat Rep. Terri Sewell of Alabama reintroduced the beal the Centers for Medicare and Medicaid Services 96-hour rule for Critical Access Hospitals like Community Hospital in McCook.“As we near the end of the Public Health Emergency, we must take steps to ensure patients – especially those in rural areas where health care options are often limited – have access to the services and care they need,” said Rep. Smith. “While I welcome the end of the PHE, enforcement of the 96-Hour rule would have a devastating impact on patient care. This is why Congress must act now to repeal it before the PHE expires.”

“Our rural hospitals have been on the front lines in the fight against COVID-19, providing lifesaving care to our most vulnerable and underserved communities,” said Rep. Sewell. “Tragically, many of these same hospitals have been struggling to keep their doors open, putting at risk the well-being of rural communities in Alabama’s 7th District and across this nation. With our bipartisan Critical Access Hospital Relief Act, we’re providing urgently needed relief so that hospitals can keep their doors open and focus on caring for their patients instead of complying with burdensome and outdated payment rules.”

“We thank Congressman Smith for continuing to introduce this legislative bill session after session,” Community Hospital President and CEO said. “I am encouraged this time we may finally succeed at getting it enacted into law. The pandemic brought front and center the dangers the 96-hour rule creates for the safety of patients and access to care. This is something we have been advocating about and warning about for at least a decade now. “There is no clinical or financial reason for this rule to exist so how has it stayed on the regulatory books for this long? You should never be told you have to be transferred to Kearney or North Platte from McCook for treatment or plan of care because you have Medicare. This is all while the person in the bed next to you, having commercial insurance, gets to stay home and be treated locally. “To provide the best explanation of how harmful this rule can be, anyone receiving Remdesivir during the past 3 years as a treatment for a COVID-19 infection in a Critical Access Hospital anywhere in rural America was violating this rule because the treatment enforced by other regulations was for 5 days. That is one day longer than allowed by Medicare.

“To comply with it, we should have transferred hundreds of patients the past few years to hospitals in larger towns to get their daily infusion. However, that was not possible because the larger facilities had zero bed availability. So, to be fully compliant, Medicare patients would not have been legally able to obtain this therapeutic and many would have died without question. It shouldn’t take a pandemic to get this issue front and center. There are other patients with non-covid treatments and plans of care every year that we are required to ship. But, only if they are on Medicare.

 “The assumptions used by the CBO years ago to suggest this could cost more for the Medicare program are shrouded in ignorance and lack even a basic understanding of how hospital finance works. Unfortunately, we are not allowed to be any part of their process to provide the understanding they should have and, as such, they have put a dollar amount, albeit very small, on the enactment of this bill. As such, the bill has for years been ignored by the larger body of congress. Maybe when their loved one is forced to be transported hours from home, they will see the importance of the issue. Maybe now that the Pandemic proved this should have been passed a decade ago, they may see the importance as well. I know Congressman Smith understands and am thankful he continues to prioritize this issue.”

The Critical Access Hospital Relief Act would repeal the 96-Hour rule, which requires physicians at Critical Access Hospitals to certify at the time of admission a patient on Medicare will be transferred before 96 hours. Providers who fail to comply would risk non-reimbursement. The 96-Hour rule has not been enforced because of enforcement stays initiated by the Trump administration and subsequent waivers related to the pandemic; however, without action, this rule could come into force following the end of the COVID-19 Public Health Emergency in May.