Washington, DC – The American Health Care Association (AHCA) submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its Policy Proposal on Admission and Medical Review Criteria for Hospital Inpatient Services Under Medicare Part A. In its comments on the proposed rule, the Association writes:
“AHCA applauds CMS’ effort in trying to minimize the uncertainty in inpatient vs. outpatient criteria. However, the proposal has created controversy among those who will have to execute it; thus, its immediate effectiveness is at stake. And it does not appear at all useful in minimizing or ending lengthy observation stays. It does not come close to providing SNF post-acute benefit protection to long stay observation patients.”
“It is AHCA’s position that CMS should move rapidly to include observation days in the count of the required three-day stay. CMS has the authority to count all days in observation status toward the three-day requirement for Medicare covered post-acute SNF care. Lengthy observation stays are an aberration of good observation medicine.”
Under the Hospital Inpatient Prospective Payment System Proposed Rule, Medicare would presume that an individual is an inpatient if the physician documents that the patient is expected to require more than two midnights in the hospital following an inpatient admission. For patients whose inpatient stay was fewer than two midnights, hospital services should be considered outpatient observation. For these patients, CMS would pay for inpatient care only if services rendered were identified on Medicare’s inpatient-only list or in other “exceptional cases.”
AHCA and its assisted living component, the National Center for Assisted Living (NCAL), have been steadfast advocates on the issue of observation stays. Last month, AHCA submitted a comment letter to CMS regarding the Agency’s proposed rule, Medicare Program; Part B Inpatient Billing in Hospitals. The Association also took the issue to the Hill during its annual Congressional Briefing, when more than 400 long term and post-acute professionals spoke to their representatives about the Improving Access to Medicare Coverage Act of 2013. Most recently, AHCA/NCAL launched a blog series, “Facing the Issue,” that features beneficiary testimonies regarding the impact of observation status and subsequent Medicare denials. AHCA/NCAL will continue to urge CMS to count all days spent in the hospital towards the three-day stay required for beneficiaries to be eligible for Medicare coverage of subsequent post-acute care in a skilled nursing care center.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit www.ahca.org or www.ncal.org.