Sen. Brown Announces Plan That Would End Arbitrary Medicare Policy Causing Seniors To Be Unknowingly Hit With Large, Unfair Costs After Receiving Necessary Medical Care

Brown’s Bill Would Fix Current Policy that Doesn’t Offer Medicare Coverage to Seniors Hospitalized on “Observation Status” Despite Receiving Necessary Post-Acute Medical Care

CLEVELAND, OH – Today, at MetroHealth Medical 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 help discuss this issue and the importance of passing this legislation was June Gold, an 84-year-old from Cuyahoga County who suffered a severe gash in her leg after her wheelchair scooter malfunctioned and tipped over. While at the hospital for five days, Gold received a transfusion for extreme blood loss and 20 staples in her leg. But because she remained under “observation status,” she was told her subsequent stay in a nursing facility wasn’t covered by Medicare, forcing her to pay a significant and unexpected bill.

Brown was also joined by Dr. James Campbell, the Director of Geriatric Health at Cleveland MetroHealth and a Professor at the Case Western Reserve University School of Medicine; and Richard Schwalberg, the Administrator of Cleveland’s Menorah Park, which provides skilled nursing care to seniors.

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.