The Centers for Medicare & Medicaid Services is once again being urged to change a rule that requires an individual to spend three consecutive days as a hospital inpatient in order to receive Medicare skilled nursing coverage.
The battle over observation stays has long been a struggle between nursing home providers and the government. Buoyed by indications that CMS Administrator Seema Verma is open to change based on a recent tweet, the American Health Care Association/National Center for Assisted Living pounced, sending a letter Monday that asked her to revisit the issue.
“AHCA/NCAL urges CMS to take action and eliminate a confusing policy barrier that each year needlessly prevents thousands of Medicare beneficiaries from accessing their benefit to high quality, post-acute care. CMS can fix this problem immediately by recognizing observation stays as qualifying stays for the purposes of the three-day stay requirement,” the association wrote.
CMS has the authority to define inpatient care and has already set a precedent allowing certain hospital stays to count toward qualifying a patient for SNF coverage, the nursing home lobbying group asserted.
“CMS has exercised this authority in certain areas of the Medicare program and could do so here as well,” the letter stated.
Medicare beneficiaries who are in the hospital under observation can be moved to a nursing home without understanding they can be on the hook for uncovered services.
Earlier this year, industry advocates praised legislative efforts to make patients under observation eligible for Medicare skilled nursing coverage. In May, a coalition of beneficiary and provider organizations, which included AHCA/NCAL, urged Congress to address observation stays while discussing surprise medical bills.
A class action lawsuit that began this month that challenges the rule. If successful, more than 1.3 million Medicare observation stay claims could be appealed.
