Bill Overview
Title: Critical Access Hospital Relief Act of 2022
Description: 2022 This bill repeals the 96-hour physician-certification requirement for inpatient critical access hospital services under Medicare. Under current law, as a condition for Medicare payment for such services, a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital.
Sponsors: Rep. Smith, Adrian [R-NE-3]
Target Audience
Population: Individuals dependent on Critical Access Hospitals for inpatient services
Estimated Size: 6000000
- Critical Access Hospitals (CAHs) primarily serve rural communities in the United States.
- Many patients in these areas depend on Medicare for their healthcare coverage.
- The bill affects a specific Medicare requirement related to stays in these hospitals, potentially altering care delivery.
- All hospital patients might potentially feel the effects due to changes in administrative or care procedures resulting from the absence of the 96-hour rule.
Reasoning
- Critical Access Hospitals (CAHs) primarily serve rural communities, who may have limited healthcare options.
- Repealing the 96-hour requirement might allow for more flexible and patient-centric care, as it reduces administrative constraints.
- The funding spread over 10 years might impact the initial speed of changes, with tailoring needed to ensure funds are optimally allocated.
- Approximately 6 million individuals may be affected based on the target population estimates for rural America relying on CAHs.
- Not everyone will have their wellbeing significantly altered, as some will experience low or no impact depending on healthcare need frequency.
Simulated Interviews
Retired farmer (Rural Kansas)
Age: 72 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- The policy seems good as it might let doctors focus more on care than paperwork.
- I often worry about being hurried out of the hospital before I'm ready.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Veteran (Rural Vermont)
Age: 65 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- It's about time they reduced the bureaucratic hoops for hospitals.
- I'm not sure how much will change, but every little helps.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Elementary school teacher (Rural Montana)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- If it means better access to care for my parents, I'm all for it.
- They shouldn't have to rush discharges just because of some rule.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 6 | 5 |
Rancher (Rural Texas)
Age: 54 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- I don't really understand all the Medicare rules, but I know this might make healthcare feel less hurried.
- I doubt anything will change overnight.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 3 |
Tech support specialist (Rural Minnesota)
Age: 31 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- This might have more impact on the older folks around here than me.
- Always a fan of reducing pointless regulations.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired school administrator (Rural Maine)
Age: 66 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- If hospitals aren't worried about the time, they might manage my care better.
- Curious to see if this changes hospital atmosphere.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Farmer (Rural Alabama)
Age: 58 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- Seems like a good move to me, no one wants to be rushed when they're sick.
- Wonder if this will affect costs at all?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired teacher (Rural Iowa)
Age: 74 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- This gives doctors more say, which is reassuring.
- Maybe they can manage the beds better with less pressure.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
Retired factory worker (Rural Ohio)
Age: 67 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- As long as it doesn't interfere with my Medicare benefits, I'm okay with it.
- Hospitals know what's best for patient care, less restriction is good.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Community volunteer (Rural Nebraska)
Age: 62 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- If it reduces the rush on discharges, I think it's a positive step.
- Not sure how much will trickle down to affect individual care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $50000000 (Low: $30000000, High: $80000000)
Year 2: $52000000 (Low: $31000000, High: $83000000)
Year 3: $54000000 (Low: $32000000, High: $86000000)
Year 5: $58000000 (Low: $34000000, High: $92000000)
Year 10: $67000000 (Low: $39000000, High: $110000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The repeal is expected to have mixed impacts with some cost increases offsetting potential savings.
- Understanding the long-term behavioral changes of hospitals is crucial in assessing the cost.
- Potential adjustments in regulations and oversight may be necessary to ensure proper patient management without the 96-hour rule.