AHCA/NCAL Supports Legislation to Waive Three-Day Stay Requirement Congressman Jim Renacci (R-OH) recently (December 20, 2017) re-introduced the Creating Access to Rehabilitation for Every Senior (CARES) Act of 2017 (H.R. 4701), which eases seniors’ access to care by permitting centers that meet specific quality measures and ratings to waive the three-day inpatient stay currently required by the Medicare program.
The CARES Act of 2017 eliminates the three-day inpatient stay required for Medicare coverage of Part A skilled nursing care benefits by allowing centers that meet particular criteria to automatically qualify to waive the prior hospitalization requirement. The criteria are based on the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare program.
AHCA/NCAL supports eliminating the three-day stay requirement and solving the related issue of observation stays. AHCA/NCAL also continues to advocate for the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421) that was introduced on March 8, 2017, by Congressmen Joe Courtney (D-CT) and Glenn “GT” Thompson (R-PA), and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL) and Shelley Moore Capito (R-WV).
This legislation ensures that time spent under “observation status” in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing care services under Medicare.
For more information about observation stays and the three-day stay requirement, please visit the AHCA/NCAL website.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
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.