Washington, DC –A panel comprised of medical experts, provider groups and families today discussed counting observation stay time in a hospital toward the three-day inpatient eligibility requirement for coverage of skilled nursing facility (SNF) services under Medicare. The panel spoke this afternoon a Capitol Hill briefing. The briefing focused on the impact the current Medicare Part A policy on observation status during a hospital stay has on those patients needing additional care at a skilled nursing facility after their stay.

“The long term care profession is eager to work with hospitals, physicians and CMS to assure that beneficiaries are not deprived of necessary and Medicare covered appropriate post-acute because of lengthy observation stays,” said Gov. Mark Parkinson, President and CEO of AHCA/NCAL.

In addition to individuals telling their stories about how the observation stay policy impacted their families, the panel heard from medical experts and provider groups that recognize the inequity the policy poses and how it jeopardizes seniors’ access to skilled nursing care. Participants included:

• Toby Edelman, Ed. M., JD, Senior Policy Attorney, Center for Medicare Advocacy
• Lee Barrows of Connecticut, widow of a beneficiary put under observation status
• Sandi Lubrant of Minnesota, daughter of a beneficiary put under observation status
• Eric Tangelos, MD, Professor of Medicine at the Mayo Clinic
• Gail Sheridan, representative for the American Health Care Association

“I have seen patients enter a skilled nursing facility after an observation stay and they are not aware that their care in the facility cannot be covered by Medicare Part A because of the lack of an inpatient stay of three days,” said Gail Sheridan, Board Chairperson of Care Providers of Minnesota and Vice President of Healthcare Services for Tealwood Care Centers, Inc. “Patients are confused and don’t understand why there is a possibility of not receiving appropriate and necessary skilled nursing care. Patients and their families deserve clarity and peace of mind that they can get the quality skilled nursing care they need.”

Currently, it is required for patients to be admitted into a hospital as an inpatient for three days in order to be eligible for skilled nursing facility care through Medicare after they are discharged. However, classifying a hospital patient as on observation stay status is a common, clinically appropriate service to treat and assess whether a patient requires further treatment or whether they are able to be discharged. Yet, Medicare Part A will not cover skilled nursing care for a patient who was put on observation status.

In many cases patients are not told whether they are classified under observation status or as an inpatient, their admissions status buried underneath paperwork. Patients who then enter a skilled nursing facility after an observation stay are not always aware that their care in the facility cannot be covered by Medicare Part A. This can result in the patient possibly foregoing appropriate and necessary skilled nursing care or forcing them to pay out-of-pocket. 

The panel represents a larger coalition of consumer groups, long term care providers, health care professionals and more that is working to correct this imbalance in care provided to America’s seniors. Those that spoke today supports legislation introduced earlier this year, the Improving Access to Medicare Coverage Act of 2011(S. 818), that would include time spent under observation status in a hospital to count toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare. The coalition also hopes to gain support for a fix to the policy through the Administration, specifically through the Centers for Medicare and Medicaid Services (CMS).

The coalition that organized today’s briefing and supports this legislation is comprised of:

• AARP
• Alzheimer’s Association
• American Health Care Association
• American Medical Directors Association – Dedicated to Long Term Care Medicine
• Center for Medicare Advocacy
• Leading Age (formerly, the American Association of Homes and Services for the Aging)
• National Committee to Preserve Social Security and Medicare

As the nation’s largest association of long term and post-acute care providers, the American Health Care Association (AHCA) advocates for quality care and services for frail, elderly and disabled Americans. Compassionate and caring employees provide essential care to one million individuals in our 11,000 not-for-profit and proprietary member facilities.