DAYTON, OH – Today, at Graceworks Lutheran Center in Centerville, U.S. Sen. Sherrod Brown (D-OH) announced a plan that would end an arbitrary Medicare policy causing seniors to be unknowingly hit with large, unfair costs after receiving necessary post-acute medical care. Under current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care on “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days.

“When seniors are transferred from a hospital to a nursing home for further care, they should be able to focus on their recovery instead of technicalities that could lead to sky high medical bills,” Brown said. “My bipartisan legislation would help ensure that seniors receive the care they need without incurring unexpected and unfair costs.”

Brown’s bill, the Improving Access to Medicare Coverage Act, would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Specifically, Brown’s bill would:

  • Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” towards the three-day hospital stay requirement for skilled nursing care; and
  • Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2013.

According to the Centers for Medicare and Medicaid Services (CMS), outpatient classification is intended for providers to run tests and evaluate patients in order to arrive at appropriate diagnoses and treatment plans, or to provide brief episodes of treatment. Typical services that are not considered “inpatient” involve emergency department services, outpatient surgery, lab testing, or x-rays. For the purposes of counting inpatient days, CMS considers a person an “inpatient” on the first day that the patient is formally admitted to the hospital because of a doctor’s order; the last is the day before discharge.

Joining Brown to discuss the importance of passing this legislation was Dolores Chambers, an 81 year-old resident at Bethany Village. In 2012, Chambers was admitted to the hospital following a fall and spent the next six days under observation status. Following her release to Graceworks rehabilitation center, Chambers was notified that due to her status as “observation,” her time spent in the hospital and at Graceworks would not be covered under Medicare.

Brown was also joined by Judy Budi, Vice-President of Residential Care at Graceworks Lutheran Services.

“As an Administrator at Bethany Village, I see firsthand the impact of the observation days process on older adults,” Judy Budi, Vice President of Residential Care said. “Each year our rehabilitation center serves over 600 individuals. We have examples of individuals that have been in the hospital for three days, six days, eight days who discover after THE FACT that part of the days were observation and they were not considered an inpatient admission. That is why we support changes to this bill.

“Many consumers do not know that they are required to have 3 days in the hospital and that these three days must be as an inpatient,” Budi continued. “If a person is in the hospital on “observation” status and not admitted, their time does not apply to the required 3 day qualifying stay. Seniors are stunned when they learn that Medicare did not pay for their rehabilitation stay.  Their recovery can be hampered by the distraction and stress of this unexpected large expense, which can be tens of thousands of dollars, for their post-acute care stay.”

The Improving Access to Medicare Coverage Act is endorsed by the American Association of Retired Persons (AARP), American Medical Association (AMA), American Health Care Association (AHCA), Center for Medicare Advocacy, American Case Managers Association, American Medical Directors Association (AMDA), American Nurses Association (ANA), LeadingAge, National Association of Professional Geriatric Care Managers, National Committee to Preserve Social Security and Medicare, and Society of Hospital Medicine. 

 

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