WASHINGTON, D.C. – Today, U.S. Sen. Sherrod Brown (D-OH) applauded a recommendation by the Medicare Payment Advisory Commission (MedPAC) that Congress should “revise the skilled nursing facility three-inpatient day hospital eligibility requirement” to ensure coverage of Medicare beneficiaries’ skilled nursing stays even if a patient was admitted under “observation status.” Currently, a Medicare beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to pay for post-hospitalization skilled nursing care. Patients that receive hospital care on “observation status” are left to pay for skilled nursing care, even if their hospitalization lasts longer than three days.
“When seniors are hospitalized, they should never be worried about whether or not they’ll be able to afford skilled nursing care after their hospital stay,” said Brown. “For too long, many seniors have been hit with unexpected costs because they didn’t know if they were hospitalized under observation status. Today’s recommendation from MedPAC to revise this policy is wonderful news for seniors who’ve been sacked with these out-of-pocket costs. My bill would make sure seniors can receive the care they need without worrying about whether that care will be covered by Medicare.”
MedPAC’s recommendation follows the introduction of Brown’s bipartisan bill, the Improving Access to Medicare Coverage Act (S. 843). The bill, cosponsored by 15 other Senators, including by U.S. Sens. Susan Collins (R-ME), Bill Nelson (D-FL), and Shelley Moore Capito (R-W.Va), would allow patients’ time under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Specifically, the 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, 2015.
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.
The Improving Access to Medicare Coverage Act is endorsed by the following organizations: American Association of Retired Persons (AARP), American Health Care Association (AHCA), Association of Jewish Aging Services (AJAS), Alliance for Retired Americans, American College of Emergency Physicians, Society for Post-Acute and Long-Term Care Medicine (AMDA), Center for Medicare Advocacy, Coalition for Geriatric Nursing Organizations, Jewish Federations of North America, Justice in Aging, Leadership Council of Aging Organizations, LeadingAge, Lutheran Services in America, Medicare Rights Center, National Association of Area Agencies on Aging (n4a), National Academy of Elder Law Attorneys (NAELA), National Association of Professional Geriatric Care Managers, National Association for the Support of Long Term Care, National Association of State Long-Term Care Ombudsman Program, National Center for Assisted Living, National Committee to Preserve Social Security and Medicare, Society of Hospital Medication, and Special Needs Alliance.