U.S. Sen. Bill Nelson (D-FL) and others reintroduced legislation today to close a loophole in Medicare that is forcing some seniors to pay more to receive the care they need at a skilled nursing facility following a hospital visit.
Under existing law, Medicare will pay for a senior to receive post-hospitalization care at a skilled nursing facility if they were admitted to a hospital on an “inpatient” basis for at least three consecutive days.
However, if a hospital chooses to admit a senior under “observation status” instead, the time they spend in the hospital under that classification does not count toward that three-day minimum.
To fix this problem, the legislation Nelson filed today along with Sens. Sherrod Brown (D-OH), Susan Collins (R-ME) and Shelley Moore Capito (R-WV) would allow seniors to count the time they spend in a hospital – whether as an “inpatient” or under “observation status” – toward the minimum three days required for Medicare to cover their skilled nursing facility care.
“Seniors have enough to worry about when they are taken to a hospital; they shouldn’t also have to worry about how the hospital is billing Medicare,” Nelson said. “This bill will help our seniors avoid the stress of potential unforeseen medical costs and focus on what’s most important: getting better.”
According to the Centers for Medicare and Medicaid Services (CMS), outpatient classification is intended for providers to run tests and evaluate patients in order to arrive at appropriate diagnoses and treatment plans, or to provide brief episodes of treatment. In a December 2016 report, the Office of the Inspector General of the Department of Health and Human Services found that an increased number of Medicare beneficiaries classified as outpatients are paying more for care that is substantively similar, and have limited access to skilled nursing facility care due to their patient status. For the purposes of counting inpatient days, CMS considers a person an “inpatient” on the first day that the patient is formally admitted to the hospital because of a doctor’s order; the last is the day before discharge.
The legislation Nelson filed today has been endorsed by more than 30 organizations, including: AARP, Alliance for Retired Americans, American Case Management Association, American Health Care Association, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, LeadingAge, National Association of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care and the Society of Hospital Medicine.
A copy of the senators’ legislation can be found here.