A bi-partisan bill introduced in the Senate and House seeks to remedy the complex and confusing rules for inpatient observation of Medicare beneficiaries.
The Improving Access to Medicare Coverage Act of 2011, introduced by Sens. John Kerry (D-Mass.) and Olympia Snowe (R-Me.) and Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa), seeks to close a coverage gap in Medicare for patients who spend more than one day in a hospital under observation status and are subsequently moved to a skilled nursing facility.
"When senior citizens get sick they need to know that they'll get the care they need. The last thing they should have to worry about is a billing technicality that could saddle them with outrageous out-of-pocket costs," said Kerry. "This bill will eliminate an unnecessary financial hardship on Medicare beneficiaries that can stand in the way of the skilled nursing care they need. I look forward to working with Senator Snowe and Congressman Courtney to bring some peace of mind to patients and their families."
The ambiguity under current law stems from patients who are admitted to a hospital under observation status. Patients are often kept longer than the prescribed limit for observation stays, which are not classified as inpatient hospital stays. According to the American Health Care Association, from 2007 to 2009 the number of patients spending four or more days in a hospital under observation status doubled.
Under current rules, patients spending that amount of time under observation who are then transferred to a skilled nursing facility face the possibility of being denied coverage under Medicare Part A, due to the lack of inpatient classification. In some cases, Medicare beneficiaries have been forced to pay for their skilled nursing care.
"This commonsense change will ensure that seniors no longer face thousands of dollars in bills for skilled care because of an arbitrary federal policy," Courtney said. "There are no two ways about it: Three days in the hospital are three days in the hospital. Anyone who meets that threshold should receive the same benefit from Medicare."