Waiving Inpatient Three Midnight Rule for Patient Admission to Skilled Nursing Facility and Subacute Rehabilitation
MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY
HOUSE OF DELEGATES
INTRODUCED BY: Montgomery County Medical Society
SUBJECT: Waiving Inpatient Three Midnight Rule for Patient Admission to Skilled Nursing Facility and Subacute Rehabilitation
REFERRED TO:
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- Whereas, CMS has had a long-standing policy requiring patients who are admitted to the hospital to
- remain in the hospital three midnights before being approved for a Medicare covered transfer to skilled
- nursing facilities or subacute rehabilitation facilities;
- Whereas, this rule was waived during COVID and it provided much greater flexibility to hospital
- medical staff members to move patients to skilled nursing facilities and subacute rehabilitation facilities
- the more appropriate location for the care needed by the patient; and
- Whereas, the waiver of this rule expired in May, 2023 and the three midnight rule was once again
- instituted and remains in force at present; and
- Whereas, the three-midnight rule was passed in 1965 at a time when care delivery in the United States
- was very different than today without the availability of adequate skilled nursing and subacute
- rehabilitation facilities; and
- Whereas, to change the three-midnight rule will require CMS and Congress to act; therefore, be it
- RESOLVED, that the MedChi American Medical Association delegation submit a resolution to the
- AMA House of Delegates to work with the Center for Medicare and Medicaid Services to request
- Congress to waive permanently the requirement for patients to remain as inpatients three midnights
- before the patient can be admitted to subacute rehab and/or skilled nursing facility.