By Patrick Cassidy.
(June 1, 2021) NORWICH, CT – Today, Representatives Joe Courtney (CT-02), Glenn ‘GT’ Thompson (PA-15), Susan DelBene (WA-01), and Ron Estes (KS-04) re-introduced the bipartisan Improving Access to Medicare Coverage Act of 2021, legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in exorbitant and unexpected out-of-pocket costs. Under current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days for Medicare to cover skilled nursing care. Hospitals are increasingly holding patients under “observation status”—an “outpatient” designation. Under outdated Medicare rules, patients who receive hospital care on “observation status” do not qualify for the benefit of skilled nursing care, even if their hospital stay lasts longer than three days and even if their care team prescribes it. These patients are either forced to return home without the treatment they have been prescribed, or, as often happens, are unexpectedly billed astronomical amounts after their stays in a skilled nursing facility (SNF). These patients can easily accrue tens of thousands of dollars in SNF bills, and recent research suggests that this policy most impacts those who can least afford it.
Although the three-day requirement has been temporarily waived during the COVID-19 pandemic, observation patients will soon be forced once again to choose between the care they need and a large SNF bill. The Improving Access to Medicare Coverage Act of 2021 would ensure Medicare covers this doctor-recommended, post-acute care even after the pandemic concludes by counting the time spent under “observation status” towards the requisite three-day hospital stay for coverage of skilled nursing care. Senator Sherrod Brown (D-OH) was the sponsor of the bill in the Senate during the previous 116th Congress, and plans to re-introduce the legislation to the Senate in the coming days.
“There are a lot of workers and families out there that are just starting to turn the corner in this recovery, and we can’t let folks go back to the same sort of debt crises in-waiting that existed prior to COVID-19,” said Rep. Courtney. “People deserve better. Whether a patient is in the hospital for three days as an inpatient, or for three days under ‘observation status’—three days is three days. Quibbling over semantics shouldn’t keep people from accessing the care their doctors have prescribed, or trap them beneath a mountain of unexpected medical debt. Our bill offers a simple, commonsense fix to Medicare’s arbitrary ‘observation status’ loophole that will help ensure seniors aren’t getting billed thousands of extra dollars in medical bills due to illogical federal policy, and I was proud to introduce it with my colleagues from both sides of the aisle. Congressman Thompson and I have worked together for years to help solve this issue, which impacts American seniors and families in every state in the country, and we’re ready to push our bill forward towards a vote this year in the 117th Congress.”
“When dealing with illness, older Americans and their families shouldn’t have to worry about financial hardships due to unexpected out-of-pocket healthcare costs,” said Congressman Thompson. “Medicare beneficiaries should be able to have peace of mind when receiving medical care advised by their physicians and certainty that Medicare will reimburse their care.”
“When seniors end up in the hospital, they and their families should be focusing on their health, not obscure Medicare rules. But many seniors who go to the emergency room aren’t ever admitted to the hospital. Rather, they are kept under observation which can lead to a significant gap in coverage when they are transferred to medically necessary rehabilitation care,” said DelBene. “This legislation would end one of the last remaining surprise medical bills and give families the peace of mind that they won’t have to make the impossible choice between quality care and economic security.”
“This common sense update will ensure Kansas seniors aren’t compromising their safety due to outdated Medicare processes and is another way of stopping surprise billing,” said Rep. Estes. “This bipartisan legislation will increase access to nursing home and rehabilitative care while maintaining Medicare’s fiscal stability for recipients.”
“Seniors should be able to focus on their recovery instead of billing technicalities and sky-high medical bills, or worse yet—trying to recover without the medical care they need because they can’t afford it,” said Senator Brown. “This legislation would improve access to the medical care seniors need, and saves money on hospital readmission costs. It’s a simple fix and the least we can do to protect our seniors from outrageous medical costs that they have no control over.”
The bipartisan bill is endorsed by AARP, Aging Life Care Association, AJAS, Alliance for Retired Americans, AMDA – The Society for Post-Acute and Long-Term Care Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Healthcare Administrative Management (AAHAM), American Association of Post-Acute Care Nursing (AAPACN), American Case Management Association, American College of Emergency Physicians (ACEP), American Geriatrics Society, American Health Care Association, American Physical Therapy Association (APTA), Center for Medicare Advocacy, Hartford Institute for Geriatric Nursing, Justice in Aging, Leadership Council of Aging Organizations, LeadingAge, Lutheran Services in America Medicare Rights Center, National Academy of Elder Law Attorneys (NAELA), National Association for the Support of Long Term Care (NASL), National Association of Health Underwriters, National Association of State Long-Term Care Ombudsman Programs (NASOP), National Center for Assisted Living, National Consumer Voice for Quality Long-Term Care, Society of Hospital Medicine, Special Needs Alliance, The Jewish Federations of North America, and The National Committee to Preserve Social Security and Medicare.
