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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. 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.

Observation Stays Coalition Submits Statement to the House Energy & Commerce Committee
Dana Halvorson

On June 12, the Energy and Commerce Health Subcommittee held a hearing entitled, “No More Surprises: Protecting Patients from Surprise Medical Bills.”  The National Observation Stays Coalition, of which AHCA/NCAL is a member, submitted a statement for the hearing record. The Coalition noted that it has come together to address the surprise medical billing issue of the observation stays matter.  Recent Capitol Hill and Administration efforts have focused on eliminating burden and unanticipated/surprise medical bills that are having a significant negative impact on out-of-pocket-costs and patient-provider relationship.  The Coalition noted in their statement that the observation stays matter is one such area that should be addressed as part of comprehensive efforts to eliminate surprise medical bills.  Counting observation status toward the 3-day inpatient requirement in the Medicare program is a common-sense policy that does not affect hospital care -- but does protect the ability of beneficiaries to receive needed post-acute nursing home care.  For more information about the observation stays issue, please visit the AHCA/NCAL website.         

House Panel Tackles Surprise Billing; Advocates Pushing for Observation Stays Inclusion
Dana Halvorson

On May 21, the House Ways and Means Subcommittee held a hearing on surprise medical billing and how to eliminate enormous charges for unsuspecting consumers.  A number of members of a coalition supporting changes to how observation stays are classified are urging the Subcommittee to include the issue in any comprehensive effort to curtail bills that cause sticker shock.  In a written statement from the National Observation Stays Coalition, which includes the American Health Care Association/National Center for Assisted Living as a member, that will be sent to the Subcommittee -- the group said it formed to address a surprise medical billing issue that affects Medicare patients in hospitals who are called observation status patients, or outpatients.  Although these individuals receive medically necessary care that is no different from the care provided to formally admitted inpatients, their classification as observation or outpatient is significant, “because the Medicare statute covers a post-hospital stay in a skilled nursing facility only if the patient was hospitalized for three consecutive days as an inpatient,” the coalition said.  The group is also noting to the Subcommittee, which is chaired by Rep. Lloyd Doggett (D-Texas), that eliminating surprise medical bills and the observation stays classification go hand in hand. 

You can read the full Provider article on this hearing here.  More on the observation stays issue can be found on the AHCA/NCAL webpage.  

New Optimism for Observation Stays Bill
Dana Halvorson

On May 14, 2019, McKnight’s released an article entitled, New optimism for hearing on ‘observation status’ bill.  The article focuses around Congressman Joe Courtney’s (D-CT) recent comments on the observation stays issue at the Center for Medicare Advocacy’s annual summit in Washington, D.C. The article includes reference to the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Courtney 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.  AHCA/NCAL strongly supports this bill along with several other national organizations.  For more information about the observation stays issue, please visit the AHCA/NCAL website.