Wednesday, March 05, 2014 '2 Midnight' Rule on Hold Until September 30 The Centers for Medicare and Medicaid Services (CMS) is once again delaying implementation of the "2 midnight" rule for hospital admissions of patients in Medicare. In the face of criticism from physicians and hospitals, CMS now says recovery auditors cannot use the rule until after September 30. The rule was originally set to go into effect on March 31. Intended to reduce costly admissions in cases better suited to outpatient treatment, the rule stipulates that auditors can assume that an admission is reasonable and necessary if the patient spent 2 days as an inpatient, defined as spending 2 midnights in a hospital bed. According to a recent report in Modern Healthcare (access requires free registration), the rule was created to respond to "widespread complaints that Medicare's rules are too vague about when a moderately sick patient should be admitted for expensive inpatient care instead of outpatient observation." The report states that hospitals have been unhappy with the assumption that they provided "medically unneeded" care if the 2-day care definitions aren't met.