• Ann M Sheehy, Charles Fs Locke, Farah A Kaiksow, W Ryan Powell, Andrea Gilmore Bykovskyi, and KindAmy JhAJHealth Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public .
• Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
• J Hosp Med. 2020 Aug 1; 15 (8): 495-497.

AbstractRarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.

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