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Berwick Urges CMS to Eliminate Three-Day Stay Medicare Requirement  
Berwick Urges CMS to Eliminate Three-Day Stay Medicare Requirement
Former CMS Administrator supports eliminating roadblock to skilled nursing care
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Washington, D.C. –The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) today applauded former Centers for Medicare and Medicaid Services (CMS) Administrator Donald Berwick for his comments urging CMS to take action to eliminate the three-day hospital stay requirement for Medicare beneficiaries seeking access to skilled nursing care.  
“We are encouraged by Dr. Berwick’s public comments advocating for more to be done to protect Medicare patients who need access to skilled nursing care,” said President and CEO Mark Parkinson.  “We hope CMS will heed the advice of its former Administrator and use its authority to once and for all address the observation stays issue.” 
In an interview with the Boston Globe, Berwick, who served as CMS Administrator from July 2010 through December 2011, stated his opinion, which aligns with AHCA/NCAL’s efforts to fully protect beneficiaries’ access to care, that officials should eliminate the three-day minimum inpatient hospital stay required by Medicare to qualify a beneficiary for skilled nursing care. This issue is particularly challenging in light of the increasing use of “observation” status in hospitals, given that this time is considered outpatient and does not count toward the three-day stay requirement.  
This public call for CMS to take more direct action to close the observation stays loophole comes on the heels of the CMS FY 2014 inpatient payment final rule, which provided doctors and hospitals guidance on conferring inpatient status for stays that cross at least two midnights and thereby  allow for coverage under the Medicare Hospital Inpatient Part A benefit. CMS believes that this change will help to reduce the use of observation days. As this final rule is implemented, AHCA/NCAL looks forward to seeing if it accomplishes this objective and improves beneficiary access to post-acute care.  
AHCA/NCAL urges CMS to use its authority to permanently address the observation stay issue and supports the elimination of the three-day stay altogether. The Association also continues to advocate for legislation, Improving Accessto Medicare Coverage Act of 2013 (S. 569/H.R. 1179), which currently has 16 bipartisan cosponsors in the Senate and 93 in the House of Representatives and would deem time an individual spends under observation status eligible to count towards satisfying the three-day requirement.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 13,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental 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 or