“When an individual is in the hospital, the only thing that should be on her mind is a healthy recovery,” said Mark Parkinson, President and CEO of AHCA/NCAL. “We should not allow technical tasks such as coding interfere with providing the best care possible in all facilities. As an advocate for seniors and those individuals requiring skilled nursing care, our Association commends Sen. Brown and Reps. Courtney and Latham for supporting this effort and focusing on the most important matter: quality care.”  

The Improving Access to Medicare Coverage Act would remedy a confusing policy that leaves seniors hanging in uncertainty regarding their access to Medicare coverage. The bill ensures that time spent under observation status in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare. Similar legislation was introduced in 2011, but received no committee consideration.

Currently, individuals who require care provided by a skilled nursing facility following an observation stay face the possibility that their care in the facility will not be covered by Medicare Part A. Under current legislation, hospital stays classified as “observation stays” do not qualify for the necessary three-day inpatient stay as required by Medicare. In turn, when an individual who has been in the hospital under observation arrives at a skilled nursing facility, they have not met the minimum stay requirements and thus are not covered by Medicare. Often, individuals are not notified in the hospital as to whether they are being admitted as an inpatient or under observation. In some instances, patients arrive at a nursing facility, and because Medicare will not cover the benefit, are forced to pay out-of-pocket.

The Improving Access to Medicare Coverage Act would close this observation stay loophole and ensure hospital stays coded as “observation” count toward the three-day stay minimum, thus easing the burden on patients to qualify for Medicare coverage. For more information on observation stays, download the AHCA Issue Brief or visit www.ahca.org. 

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The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 11,000 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.