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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. But under the current Medicare law, thousands are not receiving critical nursing care and getting stuck with high medical bills after leaving the hospital.  

Hospital patients must be classified as an inpatient for at least three consecutive days in order for Medicare to pay for rehabilitation care in a skilled nursing care center. However, hospitals are increasingly holding patients under “observation,” an outpatient designation, rather than admitting them as inpatients. As a result, outpatients who need follow-up care do not qualify for Medicare coverage in a nursing center, leaving those in need of critical care on their own or in debt with thousands in out-of-pocket costs.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) continues to keep the observation stays issue one of its top advocacy priorities and supports legislation that will fix this confusing policy.

Learn more about the observation issue here and the impact on Medicare beneficiaries here and here.

New York Times Article on Observation Stays Issue
Dana Halvorson

On September 1, 2017, the New York Times published an article written by Paula Span entitled, “Under ‘Observation,’ Some Hospital Patients Face Big Bills, on the observation stays matter.  The article focuses in on a patients impacted by the issue, and a recent federal court decision (Alexander v. Price) issued on July 31, 2017.  The decision means that Medicare patients could gain the right to appeal placement on “Observation Status” and avoid potentially large out of pocket medical bills.

AHCA/NCAL continues to keep the observation stays issue one of its top advocacy and outreach priorities.  Increasingly, patients have no idea what their status is in a hospital, or the importance of it, which can lead to thousands of dollars in out-of-pocket medical expenses should they need skilled nursing center care following their hospital stay.  In addition to placing a financial burden on seniors and their families, this anomaly in Medicare rules can cause unnecessary spend-down, accelerating the time frame in which seniors will have to turn to programs such as Medicaid to pay for their care.  For more information about the observation stays issue, please visit the AHCA/NCAL website.



Court Certifies Nationwide Class in “Observation Status” Case

The Center for Medicare Advocacy recently released a press statement on a federal court decision (Alexander v. Price) issued on July 31, 2017. The decision means that Medicare patients could gain the right to appeal placement on “Observation Status” and avoid potentially large out-of-pocket medical bills.  

In addition to being represented by attorneys from the Center for Medicare Advocacy, the class is also represented by attorneys from Justice in Aging and from the law firm of Wilson Sonsini Goodrich & Rosati. The court had previously allowed the case to proceed in a decision issued in February 2017. 

For more information about the observation stays issue, please visit the AHCA/NCAL website


Call for Stories – Observation Stays Issue
Dana Halvorson and Andrea Todd

AHCA/NCAL continues its work on the observation stays issue. Our efforts include working with the Observation Stays Coalition to support the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421). This legislation ensures observation stays count toward the Medicare-required three-day hospital stay, and the Coalition continues to connect with key members of Congress to support it.

You have helped us in the past by submitting stories that put a face on the financial and emotional impact of this issue. That stories document is on our website here and has been incredibly valuable in sharing with members of Congress. 
To boost our advocacy efforts, we need your help again! 

We are looking for more powerful stories to add to what we already have. If you have a recent beneficiary story in mind, please email dhalvorson@ahca.org and atodd@ahca.org the following for consideration:

1. No more than seven (7) sentences that captures the beneficiary’s financial and emotional impact. Please include an out-of-pocket dollar amount. See examples here.

2. The name AND written consent of the beneficiary. The authorization form here gives AHCA/NCAL permission to use the individual’s name and story.

3. The state AND city where the story took place. We would like stories from each state to take to the Hill and to others to show the importance of this matter.

We will also accept a recent local news story that identified the beneficiary. In this case, we do not need a consent form since the beneficiary gave the news outlet consent to publish their story. We will simply give the news outlet credit IF we decide to highlight the story.

For more information on this issue, visit the AHCA/NCAL Observation Stays website here.


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