After the two-midnight rule was implemented in 2014, SHM surveyed members to learn about their experiences with and perspectives on hospital observation care. In 2017, we
re-surveyed the members to get a better understanding of the state of hospital observation care after several legislative and regulatory changes had occurred over the three years. 
This paper reports on the findings from survey to display the experience members are having with the two-midnight rule and the impact of the recent Notification of Observation Treatment and Implication of Care Eligibility or the NOTICE Act. This Act requires hospitals to inform patients through the Medicare Outpatient Observation Notice or MOON form they are hospitalized under observation.