WASHINGTON, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and long term care facilities across the country that provide care to approximately five million people each year, announced its support for the bipartisan “Improving Access to Medicare Coverage Act.” The bill,
introduced by Senators Sherrod Brown (D-OH), Susan Collins (R-ME), and Sheldon Whitehouse (D-RI), would make long-needed changes to the Medicare three-day stay requirement by allowing the days Medicare beneficiaries spend in the hospital under “observation status” to count toward the minimum threshold to qualify for coverage for continued care in a skilled nursing facility (SNF). Fixing this loophole will help Medicare beneficiaries access the care they need without the unfair financial burden.
The statement is attributable to AHCA/NCAL Senior Vice President of Government Relations Clif Porter:
“We appreciate Senators Brown, Collins, and Whitehouse for introducing this important legislation, as AHCA/NCAL has advocated for this common-sense change for years. This bill is in the best interest of all Medicare beneficiaries, and we thank the senators for coming together in support of eliminating the red tape that has surrounded the three-day stay requirement. Patients who spend three days in a hospital, regardless of their inpatient or observation designation, must be able to access post-acute care in a SNF when they need it without fear of considerable out-of-pocket costs. This bill represents an important step in eliminating unnecessary challenges to accessing the care that Medicare beneficiaries need and deserve.”
Under the current Medicare law, patients covered by traditional fee-for-service Medicare must have an inpatient stay in a short-term acute care hospital spanning at least three consecutive days (not counting the day of discharge) in order for Medicare to pay for a subsequent stay in a SNF. However, acute care hospitals are patients as in “observation,” an outpatient designation, rather than admitting them as inpatients. While the care received under inpatient and outpatient designations can often be indistinguishable, outpatients do not qualify for Medicare coverage in an SNF. This puts the financial responsibility solely on the Medicare beneficiary through no fault of his or her own.
AHCA/NCAL is part of a national coalition of 33 provider and beneficiary organizations that are dedicated to preserving Medicare beneficiaries’ access to necessary skilled nursing care following a hospital stay, regardless of whether that stay was classified as inpatient or outpatient observation.