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 Residents and Families


​Has your loved one been impacted by observation stays?

Share your story with us. Please be sure to fill out the release form.


 AHCA/NCAL Members


​Have observation stays impacted your residents and patients?

Contact Us and help us close this observation stay loophole.

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Observation Stays

Skilled nursing care centers serve our most vulnerable citizens – frail elders and those with disabilities who need complex medical, rehabilitative, and restorative care, 24 hours a day, 7 days a week.

The American Health Care Association (AHCA) is concerned that Medicare beneficiaries’ access to skilled nursing facility (SNF) care is being constrained by the increased use of observation stays, which prevents patients from reaching the three-day stay threshold for Medicare coverage.

Learn more about observation stays​ and the impact​ on long term care.


 The Improving Access to Medicare Coverage Act

​Representatives Joseph Courtney (D-CT) and Tom Latham (R-IA) and
Senator Sherrod Brown (D-OH) share our concern and have introduced the
Improving Access to Medicare Coverage Act of 2013 (H.R. 1179/S. 569) to address these situations.

The Improving Access to Medicare Coverage Act of 2013 (Full Text) would deem an individual receiving “outpatient’ observation services in a hospital to be an in-patient with respect to the Medicare three-day stay requirement.


Advocates Encouraged By Political Momentum Behind Observation Stay Reforms
By Bill Myers, Senior Editor, Provider magazine

Post-acute care advocates are increasingly “optimistic” that Medicare’s troubling observation stay loophole will be closed—perhaps as early as next year, a top lobbyist tells Provider.

“The amount of attention and momentum this issue is receiving is amazing,” says Clif Porter, who heads up the government affairs department at the American Health Care Association/National Center for Assisted Living. “All of the attention is organic and coming in large part from real people and the advocacy groups that represent them.” Read more here.  Learn more about observation stays​ here. 
Observation Status Notice State Laws
By Dana Halvorson, AHCA/NCAL Senior Director of Not for Profit & Constituent Services

In June 2014, Connecticut Governor Dan Malloy signed into law a bill, HB 5535, which requires hospitals to tell patients whether their stay is classified as “observation status” or as traditional inpatient.  Without receiving this notification, many patients have been surprised to learn of the high out-of-pocket fees that they have to pay -- and thought would be covered.  The legislation takes effect on October 1, 2014.  More details about the new Connecticut law can be found in this AARP article.  Similar laws already exist in the states of Maryland and New York.  As noted in previous editions of Capitol Connection, AHCA/NCAL has been advocating on the Hill on the observation status issue.  AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.  Currently, S. 569 has 25 bipartisan cosponsors, while H.R. 1179 currently has 152 bipartisan cosponsors.  AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 30 organizations advocating for this important legislation.  Learn more about observation stays here.

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 Important Resources