This story has been updated.
A group of bipartisan lawmakers is looking to count observation stays towards the three-day stay requirement for Medicare skilled nursing facility coverage under a proposal reintroduced in the House on Tuesday.
The Improving Access to Medicare Coverage Act of 2021 aims at the requirement that was temporarily waived during the COVID-19 pandemic.
Lawmakers claimed that under the “outdated” Medicare policy hospitals are “increasingly holding patients under observation status.”
“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,” the lawmakers wrote in a statement Tuesday.
“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 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,” they added.
The legislation was first introduced in 2019 but stalled in the House Subcommittee on Health. Senators plan to introduce a companion bill in the coming days, according to the group.
The American Health Care Association applauded the bill’s introduction.
“The three-day hospital stay rule causes too many seniors who need follow-up care in a skilled nursing facility to be shackled with out-of-pocket costs in the thousands because they do not qualify for Medicare coverage. For years we have advocated to eliminate this confusing and devastating policy barrier,” Mark Parkinson, AHCA president and CEO, said in a statement late Tuesday.
“The waiver of this requirement during the COVID-19 pandemic public health emergency has benefited thousands of Medicare beneficiaries and demonstrated that eliminating this policy can work. Now it is time this issue was fixed permanently,” he added.
