Healthcare reform, News, Skilled Nursing Facility

Congress reintroduces bill to count observation stays as three-day prerequisite for SNF coverage

Congress has reintroduced a bill that would ensure patients receiving hospital care under “observation status” could count that time as part of the three-day inpatient hospital stay required to receive skilled nursing care coverage under Medicare. The Improving Access to Medicare Coverage Act of 2017 (HR 1421) mirrors a similar bill introduced in 2015.

In a press release published Wednesday, Congressman Joe Courtney called this “coverage gap” a “quiet crisis for hundreds of thousands of families that threatens access to critical nursing home care or in the alternative shifts thousands-of-dollars in costs to elderly patients. This commonsense change will ensure that seniors no longer face thousands of dollars in bills for skilled care because of this arbitrary federal policy.”

In December 2016, an investigation conducted by the Office of Inspector General (OIG) found that the two-midnight policy implemented in 2014 (or 3-day inpatient hospital stay requirement to receive SNF Medicare coverage) led to decreased inpatient stays and increased outpatient stays, leaving many beneficiaries with higher bills and limited access to skilled care. In the agency’s 2016 report, the OIG recommended that the Centers for Medicare & Medicaid Services “address these continuing vulnerabilities by improving oversight of hospital billing under the 2-midnight policy and increasing protections for beneficiaries.”

On Wednesday, Congressman Courtney said, “It is very simple: three days in the hospital is three days in the hospital. Anyone who meets that threshold should receive the same benefit from Medicare. Congress should act immediately to restore Medicare’s long history of covering nursing home care for patients after a three-day hospital stay.”

U.S. Senator Sherrod Brown expressed concern for our elderly population without the passing of this bill, stating that “seniors should be able to focus on their recovery instead of billing technicalities and sky high medical bills, or worse yet – trying to recover without the medical care they need because they can’t afford it.”

The bipartisan bill is endorsed by AARP, the American Health Care Association, the Center for Medicare Advocacy, the American Association of Directors of Nursing Services, Leading Age and the National Committee to Preserve Social Security and Medicare.

To avoid costly gaps during the pre-admission and admission process, educate your staff about skilled services covered under Medicare during HCPro’s 90-minute webinar Wednesday, April 12, 1:00 – 2:30 PM ET.

At the conclusion of this program, participants will be able to:

  • Understand who is eligible for Medicare in a SNF, and how enrollment in other programs may impact eligibility
  • Understand how hospitalizations, benefit periods, and prior SNF stays tie into their ability to accept a Medicare admission
  • Identify costly gaps in their Medicare admissions process
  • Understand the high-level criteria, straight from CMS, that define skilled services in a SNF
  • Understand what services may not be considered skilled in a SNF setting
  • Understand the appropriate process for physician certifications and recertifications

Click here to register!