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 Important Resources

 
 

 Residents and Families

 

​Has your loved one been impacted by observation stays?

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 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.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is concerned that Medicare beneficiaries’ access to skilled nursing care is being constrained by the increased use of observation stays, which prevents patients from reaching the three-day stay threshold for Medicare coverage.

Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL), Shelley Moore Capito (R-WV) and Representatives Joe Courtney (D-CT-2) and Joe Heck (R-NV-3) share our concern and have introduced the  Improving Access to Medicare Coverage Act of 2015 (S. 843/H.R. 1571) to address these situations. The Improving Access to Medicare Coverage Act of 2015 would deem an individual receiving outpatient's observation services in a hospital to be an in-patient with respect to the Medicare three-day stay requirement.

Learn more about observation staysand the impact​ on Medicare beneficiaries.

 
Comment Period Open on the Revised Medicare Outpatient Observation Notice
Dana Halvorson

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act requires hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours. Outpatient status affects a patient’s ability to receive Medicare coverage for post-acute care in a skilled nursing center. AHCA/NCAL supports the NOTICE Act law.

On August 2, 2016, the final rule from the Centers for Medicare and Medicaid Services (CMS) on the implementation of the NOTICE Act was released. A brief summary of the NOTICE Act section of the CMS final rule put together by Hancock, Daniel, Johnson & Nagle, P.C., is available here. The NOTICE Act had technically required that Medicare eligible patients receive a notice of their outpatient observation status starting on August 6, 2016. However, the CMS final rule notes that the Medicare Outpatient Observation Notice (MOON) has not yet been approved for use and is thus delaying official implementation of the law until Fall 2016.

According to an August 16, 2016, CMS email notice, beginning August 2, 2016, the public has 30 days to comment on the revised MOON under the Paperwork Reduction Act (PRA). The information collection request will be submitted to the Office of Management and Budget (OMB) for review and approval. The information collection requirements are not effective until approved under a valid OMB control number.

CMS expects final PRA approval of the MOON around the time the implementing regulations are effective. It also expects hospitals and CAHs to begin using the MOON no later than 90 calendar days from the date of final approval of the MOON by OMB. The draft MOON subject to the 30 day comment period, along with instructions on how to submit comments, can be found here. The comment period ends September 1, 2016. According to the CMS email, the Agency will provide additional information related to MOON implementation on its Beneficiary Notices Initiative webpage when the MOON is approved and in a Health Plan Management System memorandum to Medicare Advantage plans.

AHCA/NCAL’s Mark Parkinson Quoted in New York Times on the NOTICE Act
Dana Halvorson


On August 6, 2016, AHCA/NCAL’s President and CEO, Mark Parkinson, was quoted in a New York Times article on the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act. 

Parkinson was quoted in the article saying, “Patients often have no idea what their status is in a hospital. Observation stays impose a financial burden on seniors, and increase the likelihood that they will have to turn to programs like Medicaid, the federal-state program for low-income people.

The NOTICE Act law will require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours. It was sponsored by Rep. Lloyd Doggett (D-TX). Rep Doggett is also is an original cosponsor of the Improving Access to Medicare Coverage Act, which counts outpatient hospital days toward the 3-day requirement for Medicare coverage of a skilled nursing stay.

The Notice Act was passed unanimously out of Congress in summer of 2015 and requires that Medicare eligible patients receive a notice of their outpatient observation status starting on August 6, 2016. However, the Medicare Outpatient Observation Notice (MOON) has not yet been approved for use and thus delaying official implementation of the law until Fall 2016.


The August 2, 2016, final rule from the Centers for Medicare and Medicaid Services (CMS) on the implementation of the NOTICE Act can be found here. A brief summary of the NOTICE Act section of the CMS final rule put together by Hancock, Daniel, Johnson & Nagle, P.C., is here


New Hospital Suits Filed on Two-Midnight Rule
Dana Halvorson

According to a July 31, 2016, article from Emily Mongan of McKnight’s Long Term Care News, “More than 200 hospitals have filed new lawsuits in the ongoing battle between providers and the Department of Health and Human Services over its controversial ‘two-midnight’ rule. The new suits, filed on Thursday, are the latest in a series of challenges from hospitals who oppose the rule's 0.2% reduction of inpatient compensation. The earlier legal challenges led to HHS killing the payment cut in April for fiscal year 2017, and temporarily increasing payment rates. Both lawsuits, filed by a total of 211 hospitals, allege the agency violated federal regulations when it implemented the pay cuts and did not take hospital's concerns into accounts.”

The article goes on to include that, the two-midnight rule requires a “two midnight” stay in the hospital before a Medicare beneficiary’s stay is considered an inpatient admission. “The rule and its inpatient cuts were estimated to cut hospital payments by $220 million each year.”

You can read the full article here.

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