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Commission on Long-Term Care Recommends Courtney-Sponsored Modifications to Three-Day Hospital Stay Requirement for Skilled Nursing Care Coverage in Medicare

October 4, 2013
Press Release

WASHINGTON—Today, Congressman Joe Courtney (CT-2) announced that a new report issued by the Commission on Long-Term Care recommends steps to protect access to skilled nursing care for Medicare beneficiaries—an objective that legislation authored by Courtney would achieve. The Improving Access to Medicare Coverage Act (H.R. 1179) would address an issue that affects thousands of Medicare beneficiaries every year.

“I am pleased to see that the observation status problem is getting the attention it deserves,” Courtney said. “The Commission on Long-Term Care report underscores the need for a legislative solution that will protect Medicare beneficiaries from being left on the hook for expensive but necessary follow-up skilled nursing care after a hospital stay. My bill has received growing bipartisan support, and I am hopeful that we can move forward to protect seniors and their families from this unfortunate situation.”

The report is available here (observation status is addressed on page 92):

Under current Medicare law, a beneficiary must have an inpatient hospital stay of at least three days in order for Medicare to cover skilled nursing care. Patients who receive hospital care under observation status do not qualify for this benefit, even if their hospital stay lasts longer than three days.    

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.

The legislation 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;

·         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.

The bipartisan bill is endorsed by the following groups:

Leadership Council of Aging Organizations

American Association of Retired Persons (AARP)                           


AFSCME Retirees

Alliance for Retired Americans

Alzheimer’s Foundation of America

American Association of International Aging (AAIA)

American Case Management Association

American Health Care Association (AHCA)

American Medical Association (AMA)

American Medical Directors Association (AMDA)

American Nurses Association (ANA)

American Physical Therapy Association (APTA)

American Society on Aging (ASA)

Catholic Health Association of the United States (CHA)

Center for Medicare Advocacy, Inc. (CMA)

Families USA

Gray Panthers

HCR ManorCare


Lutheran Services in America (LSA)

Medicare Rights Center

National Academy of Elder Law Attorneys (NAELA)

National Association of Area Agencies on Aging (n4a)

National Association of Nutrition and Aging Services Programs (NANASP)

National Association of Professional Geriatric Care Managers (NAPGCM)

National Association of Social Workers (NASW)

National Association of State Long-Term Care Ombudsman Programs (NASOP)

National Association of States United for Aging and Disabilities (NASUAD)

National Caucus and Center on Black Aged, Inc. (NCBA)

National Committee to Preserve Social Security and Medicare (NCPSSM)

National Consumer Voice for Quality Long-Term Care

National Council on Aging (NCOA)

National Hispanic Council on Aging (NHCOA)

National Senior Citizens Law Center (NSCLC)

OWL – The Voice of Midlife and Older Women

PHI – Quality Care through Quality Jobs


Society of Hospital Medicine

Trinity and Mount Carmel Health System