Bill would fix current policy that forces seniors — simply based on their hospital status — to pay for care that Medicare should cover
Washington, D.C. – U.S. Senator Susan Collins (R-ME) joined Senators Sherrod Brown (D-OH), Sheldon Whitehouse (D-RI), and Shelley Moore Capito (R-WV) in introducing 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. Companion legislation was also introduced in the U.S. House of Representatives. Senator Collins is the Chairman of the Senate Aging Committee.
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.
“When seniors require hospitalization, their focus should be on their health and getting well, not on how they were admitted,” said Senator Collins. “The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors. This bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”
Specifically, the bill would:
- Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” toward the three-day hospital stay requirement for skilled nursing care; and
- Establish a 90-day appeal period following passage for those who have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2019.
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.