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Reps. Courtney and Thompson Introduce Legislation to End Surprise Bills, Improve Affordability and Outcomes for Medicare Patients

March 12, 2019
Press Release

WASHINGTON, DC – Today, Congressman Joe Courtney (D-CT), Congressman Glenn ‘GT’ Thompson (R-PA), and U.S. Senator Sherrod Brown (D-OH) reintroduced bipartisan, bicameral 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. However, patients are increasingly being held under “observation status,” an “outpatient” designation. 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. These patients are either forced to return home without the treatment their care team has suggested, or, as often happens, are 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.

The Improving Access to Medicare Coverage Act of 2019 would ensure Medicare covers this 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.

“This arbitrary gap in Medicare coverage is a crisis waiting to happen for so many families in eastern Connecticut and across the country,” said Congressman Courtney. “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, and quibbling over semantics should not keep Americans from accessing the care they’ve been prescribed by health care professionals, or force them to go into medical debt in order to cover the cost. This bipartisan bill introduces a commonsense change to ensure that seniors won’t face thousands of dollars in medical bills for skilled care due to illogical federal policy, and that anyone who meets the threshold of ‘three days’ in the hospital receives the same benefit from Medicare. I’m confident that the new House Majority in the 116th Congress will act on this legislation, and finally work to restore Medicare’s long history of covering nursing home care for patients after a three-day hospital stay.”

"When a person is ill, the last thing they need to worry about is anything that would prevent access to care, most of all arbitrary bureaucratic barriers," said Congressman Thompson. "This commonsense bill  will ease the minds of America's seniors and eliminate unnecessary financial hardships from unexpected out-of-pocket costs. Seniors need to seek the medical care advised by their physicians and know that Medicare will cover it."

“Seniors should be able to focus on their recovery instead of billing technicalities and sky-high medical bills, or worse yet – trying to recover without the medical care they need because they can’t afford it,” said Senator Brown. “This legislation would improve access to the medical care seniors need, and saves money on hospital readmission costs.   It's a simple fix and the least we can do to protect our seniors from outrageous medical costs that they have no control over.”

The bipartisan bill is endorsed by American Association of Healthcare Administrative Management (AAHAM), American Association of Post-Acute Care Nursing (AAPACN), AARP, American Case Management Association (ACMA), Aging Life Care Association, American Geriatrics Society (AGS), American Health Care Association (AHCA), Association of Jewish Aging Services (AJAS), Alliance for Retired Americans, American College of Emergency Physicians, American Medical Association, The Society for Post-Acute and Long-Term Care Medicine (AMDA), American Physical Therapy Association (APTA), The 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, Leadership Council of Aging Organizations, LeadingAge, Lutheran Services in America, Medicare Rights Center, National Association of Area Agencies on Aging (n4a), National Academy of Elder Law Attorneys, Inc. (NAELA), National Association of Health Care Assistants (NAHCA), National Association of Health Underwriters (NAHU), National Association for the Support of Long Term Care (NASL), National Center for Assisted Living (NCAL), National Committee to Preserve Social Security & Medicare, The National Consumer Voice for Quality Long-Term Care, Society of Hospital Medicine (SHM), and the Special Needs Alliance.