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AHCA Remains Steadfast in Analysis of Observation Stays  
AHCA Remains Steadfast in Analysis of Observation Stays

Contact: Michael Cowden

​​Washington, DC – In comments submitted today to the Centers for Medicare & Medicaid Services (CMS), the American Health Care Association (AHCA) emphasized the outstanding need to resolve the challenges Medicare beneficiaries face due to prolonged hospital stays under observation status.

“We are very appreciative of the renewed interest that CMS has taken in the plight of beneficiaries denied Medicare coverage of post-acute care because the time they spent in the hospital was in an observation stay,” Elise Smith, AHCA Senior Vice President of Finance Policy and Legal Affairs, wrote in the comments to CMS Administrator Marilyn Tavenner. “We are asking CMS to now focus on the beneficiaries and assure that none of these policies hurts them.”

AHCA specifically asked CMS that all days an individual spends in a hospital count toward the three-day stay requirement for Medicare coverage of post-acute skilled nursing care. Currently, in order to receive coverage at a post-acute care facility, patients must be admitted to a hospital under inpatient status for at least three days. If a Medicare beneficiary is hospitalized under observation status, those days spent under observation do not count towards the three-day stay minimum, and the beneficiary can be denied Medicare coverage at a post-acute care facility.

“By adapting the Medicare minimum stay requirements to include observation stays, CMS would be directly improving access to quality care for millions of Americans,” said Mark Parkinson, President & CEO of AHCA. “This is not just a dilemma of nomenclature. When Medicare coverage is denied to those individuals who desperately need skilled nursing care, it forces an unfair decision on those beneficiaries to either to pay for care out of pocket or forgo the care they need to continue their health recovery.”

AHCA’s comments to CMS can be read in full here.