U.S. Sen. Susan Collins (R) has co-sponsored a bill that aims to allow the time spent in a hospital under “observation status” to count toward the requisite three-day threshold required by Medicare for coverage of post-hospitalization skilled nursing care.
Under the current policy, only “inpatient” stays are factored into this calculation, meaning that those who are admitted for observation are ineligible for coverage of their skilled nursing care regardless of how long they were hospitalized.
The Improving Access to Medicare Coverage Act, however, would allow for both types of hospital stays to count toward this requirement.
According to Sen. Collins, this would help to reduce out-pocket-costs for seniors while simultaneously ensuring that these patients receive the care they need.
This bill would also institute a 90-day appeal period for those who had a qualifying hospital stay and were denied coverage for skilled nursing care after January 1 of this year.
Co-sponsoring this legislation alongside Collins are Sen. Sherrod Brown (D-OH) and Sen. Sheldon Whitehouse (D-RI).
“When seniors require hospitalization, their focus should be on their health and getting well, not on how they were admitted, yet currently, many older Americans face severe financial consequences due to the distinction between an observation stay and inpatient admittance,” Sen. Collins said in her press release.
“This bipartisan bill would deem time spent in observation status as inpatient care for the purpose of the Medicare three-day prior hospital stay requirement for skilled nursing care, which will help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need,” wrote Collins.
“Senator Collins’ dedication to eliminating unnecessary regulations tied to the three-day stay requirement is greatly appreciated by our over 200 long term care members in Maine,” said Angela Cole Westhoff, President & CEO of the Maine Health Care Association (MHCA). “Patients should have access to skilled nursing facilities without excessive personal costs after spending three days in a hospital. I applaud this bill for removing barriers that hinder Medicare beneficiaries from accessing the care they deserve.”
“This bipartisan bill is in the best interest of all Medicare beneficiaries, and we thank Senators Brown and Collins for being staunch supporters of eliminating the red tape that has surrounded the three-day stay requirement,” said American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Senior Vice President of Government Relations Clif Porter.
“Patients who spend three days in a hospital, regardless of their inpatient or observation designation, must be able to access post-acute care in a skilled nursing facility when they need it without fear of considerable out-of-pocket costs,” continued Porter. “We appreciate the work this bill represents in eliminating unnecessary challenges to accessing the care that Medicare beneficiaries need and deserve.”
“The Improving Access to Medicare Coverage Act of 2024 corrects the widespread problem of the Medicare program’s denying coverage to tens of thousands of Medicare beneficiaries who need skilled nursing care after their hospital stays,” said Center for Medicare Advocacy Executive Director Judith Stein. “The Medicare program should cover beneficiaries’ skilled nursing care when they have been hospitalized for three or more consecutive days, regardless of how their hospital bills the Medicare program.”
A number of medical and elder-advocacy organizations have endorsed this legislation, including AARP, the American Academy of Emergency Medicine, the American Geriatrics Society (AGS), the American Medical Association, the Center for Medicare Advocacy, Justice in Aging, National Center for Assisted Living, and the National Committee to Preserve Social Security and Medicare, among others.
Click Here to Read the Full Text of Sen. Collins’ Press Release
This is not the first time that Collins has been involved with introducing legislation aimed at addressing these concerns.
On four other occasions — including in 2021, 2017, 2015, and 2013 — Collins was among the co-sponsors for seemingly-identical versions of this bill.
It appears that an attempt was also made in 2011 to advance a similar piece of legislation, but Collins was not listed as a co-sponsor at that time.
