WASHINGTON, D.C. – U.S. Senators Shelley Moore Capito (R-W.Va.), Sherrod Brown (D-Ohio), Susan Collins (R-Maine), and Sheldon Whitehouse (D-RI) today 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.
Under 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.
“It shouldn’t cost more for West Virginia seniors to receive the care they need because of a technicality in current Medicare law,” Senator Capito said. “This loophole fix is a no-brainer that improves access and protects seniors while they’re recovering in the hospital and at their most vulnerable. I’m encouraged to see bipartisan support for this bill and know this will make a difference for thousands of Americans.”
“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,” Senator Brown said. “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.”
“When seniors require hospitalization, their focus should be on their health and getting well, not on how they were admitted,” said Senator Collins, the chairman of the Senate Aging Committee. “The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors. This bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”
“Seniors recovering from a hospitalization have a lot going on. They shouldn’t have to worry about scraping together out-of-pocket payments for the skilled nursing care they need. This bipartisan fix would protect seniors from major costs triggered by the way their hospital stay was classified,” Senator Whitehouse said.  
Specifically, the bill would:

  • Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” towards 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 January 1, 2019.


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