​​Sens. Sherrod Brown (D-Ohio), Susan Collins (R-Maine), Sheldon Whitehouse (D-R.I.), and Shelley Moore Capito (R-West Va.) have reintroduced their bipartisan legislation to update a current loophole in Medicare policy that would help protect seniors from high medical costs for the skilled nursing care they require after hospitalization.

The Improving Access to Medicare Coverage Act would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Rep. Joe Courtney (D-Conn.) is the lead sponsor of bipartisan companion legislation in the House of Representatives. The other House sponsors are Suzan DelBene (D-Wash.), Ron Estes (R-Kansas), and Glenn Thompson (R-Pa.).

Under the current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care under “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days, according to the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), a supporter of the Improving Access to Medicare Coverage Act.

“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 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.”

Collins said when seniors require hospitalization, their focus should be on their health and recovery, not on how they were admitted.
“The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors,” she said. “Our bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”

Whitehouse added that seniors trying to recover shouldn’t have to worry about accessing the skilled nursing care they need. This bipartisan legislation would fix a quirk in the billing rules that forces patients into stressful and pointless long stays in the hospital, he said.

“West Virginia’s seniors shouldn’t have to pay more for their health care because of a technical loophole in our current Medicare law,” Capito said. “The Improving Access to Medicare Coverage Act is a commonsense bill to right this wrong and protect seniors while they’re recovering in the hospital and at their most vulnerable. This bipartisan effort would take a crucial step forward in improving access to care for our seniors.”

 AHCA/NCAL said the nursing care profession backs the legislative effort in the Senate. “Our nation’s skilled nursing facilities are privileged to help America’s seniors receive the therapy and care they need after a hospital stay, but Medicare’s three-day hospital stay requirement is arbitrary and unfair,” said AHCA/NCAL President and Chief Executive Officer Mark Parkinson.

“Too many seniors are left to foot the bill for their post-acute care, all because their hospital stay was coded as under observation. They deserve the chance to recover without worrying about how they’re going to pay for it. We greatly appreciate Sens. Brown, Capito, Collins, and Whitehouse for leading this charge once again, and we urge Congress to swiftly pass this legislation,” he said.

Specifically, the bill would:

• Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” toward the three-day hospital stay requirement for skilled nursing care; and

• Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2021.

The Improving Access to Medicare Coverage Act 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 Academy of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security & Medicare, National Consumer Voice for Quality Long-Term Care, and the Society of Hospital Medicine.