CLEVELAND -- U.S. Sen. Sherrod Brown announced a plan that would end a Medicare policy causing seniors to be unknowingly hit with large costs after receiving necessary post-acute medical 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 on "observation status" do not qualify for this benefit, even if their hospital stay lasts longer than three days.
"When seniors are transferred from a hospital to a nursing home for further care, they should be able to focus on their recovery instead of technicalities that could lead to sky-high medical bills," Brown said.
Brown's bill, the Improving Access to Medicare Coverage Act, has bipartisan support and 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.
Specifically, Brown's 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.
- 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, 2013.
According to the Centers for Medicare and Medicaid Services, outpatient classification is intended for providers to run tests and evaluate patients in order to arrive at appropriate diagnoses and treatment plans, or to provide brief episodes of treatment. Typical services that are not considered "inpatient" involve emergency department services, outpatient surgery, lab testing or X-rays.
For the purposes of counting inpatient days, CMS considers a person an "inpatient" on the first day that the patient is formally admitted to the hospital because of a doctor's order; the last is the day before discharge.
Brown hopes to get the bill passed some time this year.