Youngstown, OH – Today, at the St. Elizabeth Health Center, 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 this issue was Mahoning Valley resident, Mary Beth McKnight Potts. McKnight Potts told the story of her aunt, Frances Necko, an Austintown senior citizen who has been undergoing treatment for a rare form of Parkinson’s disease and recently had a 10 day hospital stay. Shortly after being discharged, Necko still experienced difficulty and needed additional care. She was terrified, however, of returning to the hospital and being put under “observation status” and having to pay medical bills she couldn’t afford. Because of the risk, she decided to forgo additional treatment. 

“We need to get rid of red tape that keeps people, especially the disabled and elderly, from getting the care they need,” McKnight Potts said. “Seniors are already overwhelmed and scared because they are ill, but that’s all made worse when they worry that they will be over charged or unable to get the coverage for what they need. Anyone, like Senator Brown, who is trying to fix these problems and make care more accessible to seniors, should be commended.” 

Brown was also joined by Don Koenig, the Executive Vice President of the Humility of Mary Health Partners; and George Semer, the Director of Care Coordination of the Humility of Mary Health Partners.

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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