May 16, 2024 - Washington, D.C. – On Wednesday, U.S. Senator Susan Collins, along with Senators Sherrod Brown (D-OH) and Sheldon Whitehouse 
(D-RI), has introduced new 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.
“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,” said Senator Collins. “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.”
Under the 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.
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, 2024.
"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. 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. 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,” said Center for Medicare Advocacy Executive Director Judith Stein.
The legislation is endorsed by AARP, ADVION, AMDA, American Academy of Emergency Medicine, American College of Emergency Physicians, American Geriatrics Society (AGS), American Health Care Association (AHCA), American Medical Association, APTA, Association of Jewish Aging Services (AJAS), Catholic Health Association of the United States, Center for Medicare Advocacy, Justice in Aging, LeadingAge, Lutheran Services in America, National Center for Assisted Living, National Committee to Preserve Social Security and Medicare.
Source: Senator Susan Collins
