Senate bill would alter Medicare nursing home mandate

NEWS IN BRIEF — Posted March 4, 2013

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Medicare patients would gain skilled nursing facility coverage after three days in the hospital regardless of admission status under legislation proposed in the Senate.

Medicare law requires beneficiaries to stay at least three days as a hospital inpatient before the entitlement program will cover postacute care in a nursing facility. Hospital care while in observation, technically an outpatient service, does not count toward the minimum for skilled nursing facility coverage. Patients without at least three inpatient days must pay for postacute facility care out of pocket.

Many patients are unaware of the policy, said Sen. Charles Schumer (D, N.Y.), who spoke on Feb. 20 about his legislation to address the problem. The bill would change Medicare law so observation stays count toward the three-day requirement.

“A flawed Medicare law is to blame, and I have a plan to change that, so hundreds of thousands of seniors … are not hit with huge rehabilitation bills after a lengthy hospital visit,” he said.

The American Medical Association has supported changing the coverage requirement to minimize financial exposure for patients. An increase in audits targeting admissions has exacerbated the problem, with hospitals sometimes changing patients’ status retroactively in order to avoid payment denials.

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