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Congressman Joe Courtney

Representing the 2nd District of Connecticut

Alongside Patients, Families and Medical Professionals, Courtney Announces Bill to Restore Promise of Medicare Coverage

March 23, 2015
Press Release

Bipartisan Improving Access to Medicare Coverage Act would restore coverage rules for skilled nursing care

Vernon, CT—Today, at Vernon Manor Health Care and Rehabilitation, Congressman Joe Courtney (CT-2)  announced the reintroduction of his bipartisan bill to restore Medicare coverage of follow-on skilled nursing care for seniors who have a three or more day stay in the hospital.

“For seniors on Medicare, coverage of rehabilitative care after a stay in the hospital can be a financial lifesaver,” Courtney said. “Because of the rising number of ‘observation status’ stays in the hospital, hundreds of thousands of seniors each year are left to pay out-of-pocket for the full cost of doctor-prescribed skilled nursing care—which can amount to tens of thousands of dollars. Since I began this effort in 2010, I have heard from families and advocates all over the country, who have faced devastating medical bills due to this gap in coverage.

“My bill would fix this problem by counting all days spent in the hospital—whether admitted or on ‘observation’—toward the three-day requirement to qualify for Medicare coverage. This is a bipartisan effort that has been gaining momentum as more seniors and their families learn about this problem firsthand,” Courtney said.

Judith Stein, Founder and Executive Director, Center for Medicare Advocacy: “The Congressman is a longtime champion of Medicare and Medicare beneficiaries. This bill will end one of the worst consequences of the unfair Observation Status policy.”

Courtney was joined at the press conference by Nancy Renshaw of Bozrah, whose family dealt with the observation status issue in 2010 when her father in law suffered a fall, and spent four days in the hospital under “observation.” Because of this classification, her family paid more than $10,000 out-of-pocket to have him admitted to a skilled nursing facility for additional care after leaving the hospital. 

The Improving Access to Medicare Coverage Act of 2015 would count all time beneficiaries spend in the hospital toward the three-day inpatient requirement necessary to receive Medicare coverage for post-hospital care. Currently, Medicare only pays for post-hospital skilled nursing facility care when patients are formally classified as inpatients for three days. Medicare will not pay for such care when the increasingly common outpatient “observation status” classification is used, even when a patient remains under observation for three or more days. 

The “observation status” problem creates very significant out-of-pocket costs for necessary, doctor-prescribed care. While Connecticut requires hospitals to notify patients of their status, most other states do not—meaning that patients and their families often do not learn that they do not qualify for coverage until they are being discharged from the hospital, and have little recourse to appeal the decision.

First introduced in 2010, the Improving Access to Medicare Coverage Act received broad bipartisan support in the 113th Congress, and wide-ranging support from national advocacy groups, including AARP, the American Medical Association (AMA), the American Health Care Association (AHCA), the American College of Emergency Physicians, and the Connecticut-based Center for Medicare Advocacy.