WASHINGTON, D.C. – Today, U.S. Sen. Sherrod Brown (D-OH) reintroduced 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.
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 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.”
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, 2017.
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. In a December 2016 report, the Office of the Inspector General of the Department of Health and Human Services found that an increased number of Medicare beneficiaries classified as outpatients are paying more for care that is substantively similar, and have limited access to skilled nursing facility care due to their patient status. 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 on a conference call to discuss the importance of passing this legislation was Edie Horvat, of Lakewood, whose 90 year old mother was ambulanced to the emergency room and subsequently had to stay in the hospital for four nights. But because she was under “observation status,” Medicare wouldn’t pay for the necessary nursing home care she received after discharge.
“After my mother was sent to the hospital by ambulance for intense pain, the hospital kept her under observation status for four nights. When she was released from the hospital, we soon discovered that the nursing home care she needed was not covered under Medicare. This legislation is important so that patients like my mother can get the care they need without worrying about the high cost of the medical care they require,” said Horvat.
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 Association of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, and the Society of Hospital Medicine.