The traditional Medicare program limits coverage in a skilled nursing facility (SNF) to individuals who were first hospitalized as inpatients for at least three consecutive days. The Centers for Medicare & Medicaid Services waived the 3-day inpatient requirement for two years during the COVID-19 pandemic and reinstated the requirement on May 12, 2023, when the public health emergency ended.
A national retrospective study evaluated 332,044 hospitalizations during the waiver of the 3-day inpatient requirement and 388,374 hospitalizations after reinstatement of the requirement. The study finds that reinstatement increased the proportion of hospitalizations that lasted at least three days and resulted in between 2064 and 5617 additional inpatient days just in the 28 days after the 3-day rule was reinstated. However, reinstatement of the rule did not shorten beneficiaries’ SNF stays.
Essentially, the study finds that the 3-day inpatient requirement increases Medicare costs and does not improve patients’ health outcomes.
The researchers find, “This study provides rigorous empirical evidence that the 3-day rule may not serve its intended function of screening unnecessary postacute SNF use and instead results in additional inpatient days that burden hospitals, clinical practice, and potentially patients.” They conclude, “Because the policy appeared to prolong hospital stays without improving outcomes or achieving Medicare savings among inpatients, these findings raise questions regarding the value and continued relevance of a broadly applicable 3-day inpatient stay rule in the traditional Medicare program.”
Congressman Joe Courtney (D-CT) and colleagues have introduced legislation in Congress for more than a decade that would count all time spent in a hospital, including outpatient time in observation status, towards satisfying the 3-day inpatient requirement. The current bill is the Improving Access to Medicare Coverage Act of 2025, H.R. 3954. The Center for Medicare Advocacy strongly supports the legislation and also supports repealing the statutory 3-day requirement. The new study supports both efforts.
For more information see: Zhan Chen, et al, “Changes in Inpatient and Skilled Nursing Facility Care After the Medicare 3-Day Rule Reinstatement,” JAMA Internal Medicine (Feb. 9, 2026). Abstract
January 12, 2026 – T. Edelman