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 Important Resources

 
 

 Residents and Families

 

​Has your loved one been impacted by observation stays?

Share your story with us. Please be sure to fill out the release form.

 

 AHCA/NCAL Members

 

​Have observation stays impacted your residents and patients?

Contact Us and help us close this observation stay loophole.

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 Press Releases

 

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.

PBS NewsHour Story on Observation Stays Issue and Surprise Medical Bills
Dana Halvorson

On April 3, PBS NewsHour released a story by Philip Moeller titled, “How this Medicare loophole can lead to surprise medical bills.” The full article can be found here, and focuses on the observation stays issue. Thirty-three national organizations, including AHCA/NCAL, supports the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Joe Courtney (D-CT) and Glenn 'GT' Thompson (R-PA) and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV), the 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 the observation stays issue, please visit the AHCA/NCAL website.        

Observation Status Lawsuit Update
Dana Halvorson

The Center for Medicare Advocacy released a March 28, 2019, press statement titled, “Court Denies All Government Motions in Class Action Seeking Appeal Right for Medicare Beneficiaries on ‘Observation Status.’” The statement included that “in a decision issued on March 27, 2019, a federal judge denied multiple attempts by the federal government to halt a lawsuit by Medicare patients seeking a right to appeal their placement on ‘outpatient observation status’ in hospitals.  Alexander v. Azar is a nationwide class action brought by individuals who were forced to pay up to $30,000 for post-hospital skilled nursing facility care because they had been classified as outpatients in observation status, rather than as inpatients.”

The statement goes on to include that, “Although care provided to patients on observation status is often indistinguishable from inpatient care, it does not count toward the three-day inpatient hospital stay requirement for Medicare coverage of nursing home care. This leaves beneficiaries with the burden of paying for – or forgoing – extremely costly nursing and rehabilitative care.  The opportunity to appeal is critical because of the severe ramifications that can result from the observation status categorization.”  McKnight’s also published an article around the court decision titled, “Lawsuit over observation status, SNF payment finally going to trial.” 

33 national organizations, including AHCA/NCAL, supports the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Joe Courtney (D-CT) and Glenn 'GT' Thompson (R-PA) and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV), the 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 the observation stays issue, please visit the AHCA/NCAL website.         

Recent HHS Office of the Inspector General Report and SNF Payments
Dana Halvorson

On February 14, 2019, the Office of the Inspector General (OIG) released a report citing improper payments to SNFs when a qualifying three-inpatient nights hospital stay was not met.  Last month, McKnight’s issued an article on the report, and AHCA’s Clif Porter, Senior VP of Government Relations, is quoted.  Most recently, on March 25, 2019, a blog was published in Health Affairs titled, “What the Inspector General Gets Wrong About Reforming Observation Hospital Care.”  The blog article includes support for the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Joe Courtney (D-CT) and Glenn 'GT' Thompson (R-PA) and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV), the 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 the observation stays issue, please visit the AHCA/NCAL website.         

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