American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS Continues to Support Eliminating the 96-Hour Rule for Critical Access Hospitals

The American College of Surgeons (ACS) February 12 sent a letter of support for the Critical Access Hospital Relief Act, H.R. 1041, to Reps. Adrian Smith (R-NE) and Terri Sewell (D-AL). This legislation would remove the 96-hour physician certification requirement as a condition of payment for inpatient critical access hospital (CAH) services under Medicare.

The CAH 96-hour rule creates a condition of payment that requires a physician to certify that a patient can reasonably be expected to be discharged or transferred within 96 hours. CAHs already must meet a separate condition of participation, which requires that acute inpatient care provided to patients not exceed 96 hours per patient on an average annual basis. The Centers for Medicare & Medicaid Services in its fiscal year 2018 Medicare Inpatient Prospective Payment System final rule made the 96-hour rule a low priority for medical record reviews; however, the ACS has advocated for a statutory fix to fully repeal this certification requirement.

A copy of the letter is available here. For more information on this issue, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at