WASHINGTON, D.C. – Today, U.S. Sens. Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI), and Shelley Moore Capito (R-WV) reintroduced their bipartisan legislation to update a current loophole in Medicare policy that would help protect seniors from high medical costs for the skilled nursing care they require after hospitalization. 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. Representative Joe Courtney (CT-02) is the lead sponsor of bipartisan companion legislation in the House of Representatives.
Under the 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 under “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days.
“Seniors should be able to focus on their recovery instead of billing technicalities and sky high medical bills, or worse yet – trying to recover without the medical care they need because they can’t afford it,” said Senator Brown. “This legislation would improve access to the medical care seniors need, and saves money on hospital readmission costs. It's a simple fix and the least we can do to protect our seniors from outrageous medical costs that they have no control over.”
“When seniors require hospitalization, their focus should be on their health and recovery, not on how they were admitted,” said Senator Collins. “The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors. Our bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”
“Seniors trying to recover shouldn’t have to worry about accessing the skilled nursing care they need. This bipartisan legislation would fix a quirk in our billing rules that forces patients into stressful and pointless long stays in the hospital,” said Senator Whitehouse.
“West Virginia’s seniors shouldn’t have to pay more for their health care because of a technical loophole in our current Medicare law,” said Senator Capito. “The Improving Access to Medicare Coverage Act is a commonsense bill to right this wrong and protect seniors while they’re recovering in the hospital and at their most vulnerable. This bipartisan effort would take a crucial step forward in improving access to care for our seniors.”
“When someone is admitted to the hospital, the last thing they have on their minds are billing codes or Medicare technicalities. To saddle people with thousands of dollars in bills can be financially ruinous and can even force people to forgo the care they need. AARP applauds this bipartisan bill to cut through the red tape and help seniors get the care they need,” said Bill Sweeney, Senior Vice President of Government Affairs for AARP.
“It’s time to stop harming Medicare beneficiaries over a billing technicality. This legislation, and the companion House bill (H.R. 3650), will allow all Medicare beneficiaries who spend three days in the hospital getting necessary care to receive the nursing home and home care they require,” said Judith Stein, Executive Director of the Center for Medicare Advocacy.
“Our nation’s skilled nursing facilities are privileged to help America’s seniors receive the therapy and care they need after a hospital stay, but Medicare’s three-day hospital stay requirement is arbitrary and unfair. Too many seniors are left to foot the bill for their post-acute care all because their hospital stay was coded as under observation. They deserve the chance to recover without worrying about how they’re going to pay for it. We greatly appreciate Senators Brown, Capito, Collins, and Whitehouse for leading this charge once again, and we urge Congress to swiftly pass this legislation,” said Mark Parkinson, President and CEO, American Health Care Association/National Center for Assisted Living (AHCA/NCAL).
“Before the pandemic, we frequently heard from our Ohio members that patients were being denied their right to skilled nursing care because their hospital stay was coded as observation. We strongly support this important measure to protect our seniors’ Medicare benefits,” said Pete Van Runkle, Executive Director, Ohio Health Care Association.
Specifically, the bill would:
The Improving Access to Medicare Coverage Act has been endorsed by more than 30 organizations including: AARP, Alliance for Retired Americans, American Case Management Association, American Health Care Association, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, LeadingAge, National Academy of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security & Medicare, National Consumer Voice for Quality Long-Term Care, the Society of Hospital Medicine, and the American Medical Association.
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