WASHINGTON, D.C. – Today, U.S. Senators Shelley Moore Capito (R-W.Va.), Sherrod Brown (D-OH), Susan Collins (R-ME) and Bill Nelson (D-FL) introduced legislation to end a Medicare policy that causes seniors to be charged unknowingly with high, unfair costs after receiving needed post-acute medical care.

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.

“This important legislation will provide certainty to seniors who are in need of skilled nursing care and take away a source of significant financial worry for patients and their families,” said Capito.  “I am proud to join my colleagues to introduce this bipartisan legislation that will end confusion and help seniors access the care they need.”

The Improving Access to Medicare Coverage Act (S. 843) 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.

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