Administrative Memos

200002

FROM: Theodore O. Will, Chief Executive Officer
DATE: Feb 18, 2000
SUBJECT: Elimination of the 96-hour Critical Access Hospital (CAH) Review
IPRO CONTACTS:

Andrea Goldstein, ext. 364

The purpose of this memorandum is to provide notification as to the elimination of the Peer Review Organization (PRO) review requirement pertaining to a CAH's request for an extension of a 96- hour acute care stay based on medical necessity.

The elimination is due to an amendment of the Balanced Budget Refinement Act (BBA) of 1999 which became effective on November 29, 1999. Section 403 of the BBA now states that a CAH is required to provide "inpatient care for a period that does not exceed, as determined on an annual, average basis, 96 hours per patient." Therefore, effective immediately, a CAH is no longer required to call IPRO to request an extension of a medically necessary admission beyond a 96-hour stay (IPRO Medicare Administrative Memorandum #99-05).

Should you have any questions in regard to this memorandum please feel free to contact Andrea Goldstein, Vice President, Health Care Assessment.