Congressman Joe Courtney (D-CT), Congressman Tom Latham (R-IA), and Senator Sherrod Brown (D-OH) have introduced legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care. Under current Medicare policy, a beneficiary must have an "inpatient" hospital stay of at least three days in order for Medicare to cover 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.
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.
"This common sense change will ensure that seniors no longer face thousands of dollars in bills for skilled care because of an arbitrary federal policy," Congressman Courtney said. "There are no two ways about it: three days in the hospital are three days in the hospital. Anyone who meets that threshold should receive the same benefit from Medicare."
"Seniors should not have to foot expensive, unexpected medical bills for services that Medicare is supposed to cover just because of a simple technicality," Congressman Latham said. "Medicare benefits exist to provide seniors with affordable access to the highest quality health care available, and I am pleased to join my colleagues on a bipartisan basis to address this issue to help keep costs low and fair."
"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," said Sen. Brown. "This bill would help ensure that seniors receive the care they need without incurring unexpected and unfair costs."
The bipartisan bill is endorsed by the following groups:
AARP, American Medical Association (AMA), American Health Care Association (AHCA), the 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, Society of Hospital Medicine
The legislation 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;
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.