Rep. Courtney Leads Bipartisan Lawmakers in Introducing Legislation to End Surprise Bills, Improve Affordability for Medicare Patients
NORWICH, CT – Today, Representatives Joe Courtney (D-CT-02), Glenn ‘GT' Thompson (R-PA-15), Susan DelBene (D-WA-01), and Ron Estes (R-KS-04) re-introduced the bipartisan Improving Access to Medicare Coverage Act of 2023, legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in exorbitant and unexpected out-of-pocket costs.
Under current Medicare policy, a beneficiary must have an "inpatient" hospital stay of at least three days for Medicare to cover skilled nursing care. Hospitals are increasingly holding patients under "observation status"—an "outpatient" designation. Under outdated Medicare rules, patients who receive hospital care on "observation status" do not qualify for the benefit of skilled nursing care, even if their hospital stay lasts longer than three days and even if their care team prescribes it. These patients are either forced to return home without the treatment they have been prescribed, or, as often happens, are unexpectedly billed astronomical amounts after their stays in a skilled nursing facility (SNF). These patients can easily accrue tens of thousands of dollars in SNF bills, and recent research suggests that this policy most impacts those who can least afford it.
During the COVID-19 Public Health Emergency, the three-day requirement was waived, allowing patients to receive SNF care regardless of their hospital status. Now, the policy is being reimposed on beneficiaries, causing confusion, unexpected bills, and delays in care.
The Improving Access to Medicare Coverage Act of 2023 would ensure Medicare covers doctor-recommended, post-acute care by counting the time spent under "observation status" towards the requisite three-day hospital stay for coverage of skilled nursing care.
"People deserve better. Whether a patient is in the hospital for three days as an inpatient, or for three days under ‘observation status'—three days is three days. Quibbling over semantics shouldn't keep people from accessing the care their doctors have prescribed, or trap them beneath a mountain of unexpected medical debt. Our bill offers a simple, commonsense fix to Medicare's arbitrary ‘observation status' loophole that will help ensure seniors aren't getting billed thousands of extra dollars in medical bills due to illogical federal policy,” said Rep. Courtney. “We addressed this problem during the COVID-19 pandemic by temporarily waiving the three-day policy. That limited-time waiver serves as solid evidence that we can and should eliminate this arbitrary rule for good.”
"When dealing with illness, older Americans and their families shouldn't have to worry about financial hardships due to unexpected out-of-pocket healthcare costs," Rep. Thompson said. "Medicare beneficiaries should be able to have peace of mind when receiving medically care and certainty that Medicare will cover these costs."
"Kansas seniors on Medicare deserve access to the full range of treatment and care they need, unimpeded by outdated policies that result in costly bills," said Rep. Estes. "This common sense legislation updates Medicare’s policy on skilled nursing care to make it more efficient and lead to better outcomes for patients."
“Designating a patient in “observation” rather than inpatient status is a hospital billing decision, not a medical determination. But this designation deprives Medicare patients of benefits to which they’re entitled, care they need, and can also cost them thousands of dollars in health care bills. We thank Mr. Courtney for his tenacious commitment to correcting this longstanding problem and to ensuring that all Medicare patients receive the Medicare-covered care they need,” Judy Stein, Executive Director, Center for Medicare Advocacy.
“We thank Representatives Courtney, Thompson, Estes, and DelBene for re-introducing the Improving Access to Medicare Coverage Act,” said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living. “Seniors who spend three days in a hospital, regardless of their inpatient or observation designation, must be able to recover safely in a skilled nursing facility when they need it without fear of considerable out-of-pocket costs. It’s time to eliminate this confusing, costly policy and barrier to post-acute care, and this legislation will best serve our Medicare beneficiaries as well as the Medicare Trust fund.”
Endorsing Organizations: AARP; ADVION (formerly National Association for the Support of Long Term Care); Aging Life Care Association®; Alliance for Retired Americans; AMDA – The Society for Post-Acute and Long-Term Care Medicine; American Association of Healthcare Administrative Management (AAHAM); American Association of Post-Acute Care Nursing (AAPACN); American Case Management Association (ACMA); American College of Emergency Physicians (ACEP); American College of Physician Advisors (ACPA); American Geriatrics Society (AGS); American Health Care Association (AHCA); American Medical Association; American Physical Therapy Association (APTA); Association of Jewish Aging Services (AJAS); Catholic Health Association of the United States (CHA); Center for Medicare Advocacy; The Hartford Institute for Geriatric Nursing; The Jewish Federations of North America; Justice in Aging; LeadingAge; Lutheran Services in America; Medicare Rights Center; National Academy of Elder Law Attorneys, Inc.(NAELA); National Association of Benefits and Insurance Professionals (NABIP); National Association for State Long-Term Care Ombudsman Programs (NASOP); National Center for Assisted Living (NCAL); National Committee to Preserve Social Security & Medicare; The National Consumer Voice for Quality Long-Term Care; National Council on Aging (NCOA); NJHSA – the Network of Jewish Human; Service Agencies; Society of Hospital Medicine (SHM); Special Needs Alliance; USAging.