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Representative Courtney Highlights Observation Stays Legislation  
Representative Courtney Highlights Observation Stays Legislation
Congressman visits with affected patients
Michael Cowden


Washington, DC – The American Health Care Association (AHCA) today welcomed Congressman Joe Courtney to Beechwood Rehabilitation and Nursing Center in New London, CT. A champion of closing a costly loophole for seniors, Courtney introduced bipartisan legislation in both Houses of Congress last spring to remedy the complex and confusing process resulting from observation status during a hospital stay.

The Improving Access to Medicare Coverage Act of 2011 would rectify a confusing policy that leaves seniors hanging in uncertainty regarding their healthcare delivery. The bill ensures that time spent under observation status in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.

“This commonsense change will ensure that seniors no longer face thousands of dollars in charges for skilled care because of an arbitrary federal policy,” said Congressman Courtney. “There are no two ways about it: three days in the hospital are three days in the hospital. Anyone who meets that threshold should receive the same benefit from Medicare.”

Often hospital patients are kept much longer than the prescribed limit for observation stays and are not informed of their admission status. In fact, from 2007-2009 the number of hospital patients spending four or more days under observation status increased by 88 percent.

Patients who need to enter a skilled nursing facility following an observation stay face the possibility that their care in the facility will not be covered by Medicare Part A because of the lack of hospital classification as an inpatient. Medicare Part A typically requires an inpatient hospital stay prior to authorizing skilled nursing care. This can result in patient confusion and the possibility of not receiving appropriate and necessary skilled nursing rehabilitation care. In some instances, patients arrive at a nursing facility, and because Medicare will not cover the benefit, are forced to pay out-of-pocket.

“My 98-year-old aunt and our entire family had to deal with two visits to the hospital, which resulted in not having a three-day qualifying stay but her needing a skilled nursing and rehab facility,” said Candance Antrop. “I had to cope with the stress of dealing with these bureaucratic guidelines and watch helplessly while her money disappeared.”

“The general public does not understand why this regulation was created and why it cannot be abolished,” said Kathleen Pajor, President and Executive Director of the Beechwood Center. “Congressman Courtney understands and he is willing to stand up for others who have gone through situations just like Ms. Antrop’s aunt.”

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