CARES Act would waive three-midnight requirement for nursing facilities with high quality ratings

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Certain skilled nursing facilities could provide Medicare-covered services to beneficiaries without a preceding hospital stay, under a new bill in the U.S. House of Representatives.

Currently, Medicare covers skilled nursing services only for people who first spend three midnights as a hospital inpatient. The “Creating Access to Rehabilitation for Every Senior (CARES) Act” would eliminate this three-midnight requirement for SNFs that meet certain quality benchmarks. The bill was introduced Tuesday by Rep. Jim Renacci (R-OH).

“This bill encourages mutual, positive relationships between individuals seeking skilled care and facilities who work hard to achieve high quality ratings,” stated Clif Porter, incoming head of government affairs for the American Health Care Association/National Center for Assisted Living.

AHCA/NCAL, the nation's largest provider association, has thrown its support behind similar bills in the House and Senate.

The three-midnight requirement is widely derided by long-term care advocates. Some call it unnecessary, due to the increasing ability of SNFs to treat high-acuity cases. The rule also has run up against the increasing use of observation status. Hospitals, facing readmissions penalties, reimbursement scrutiny and other pressures, have been keeping people under observation status for days — time that does not count toward the three-midnight threshold.

A recent rule change meant to cut down on observation stays has run up against opposition from the American Medical Association and the American Hospital Association. The organizations have called for the new policy to be delayed, and for stakeholders to collaborate on different solutions.