Washington, DC – U.S. Senators Sheldon Whitehouse (D-RI), Sherrod Brown (D-OH), Susan Collins (R-ME), and Shelley Moore Capito (R-WV) have reintroduced 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.
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 recovering from a hospitalization have a lot going on. They shouldn’t have to worry about scraping together out-of-pocket payments for the skilled nursing care they need. This bipartisan fix would protect seniors from major costs triggered by the way their hospital stay was classified,” said Whitehouse.
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, 2019.
Representative Joe Courtney (CT-02) is the lead sponsor of bipartisan companion legislation in the House of Representatives.
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.