Bill would end hospital inpatient requirement for SNF Medicare coverage
Dedicated observation stay units could protect nursing home benefits, save hospitals $1 billion annu
Medicare beneficiaries would be eligible for Part A coverage of skilled nursing care without a preceding hospital stay under a new bill introduced by Rep. Jim McDermott (D-WA).
Currently, Medicare Part A only reimburses for skilled nursing facility care after a person has spent at least three days as a hospital inpatient. However, SNFs now can provide services that used to be available only in hospitals, McDermott stated when introducing his legislation Thursday. Eliminating the three-day inpatient rule would also resolve the urgent problem of hospitals keeping people for extended stays under “observation” status, which does not qualify a person for SNF coverage.
Under McDermott's proposal, a physician or other qualified healthcare professional would have to certify the need for skilled care. The Department of Health and Human Services would be responsible for drafting “a set of uniform requirements” that Medicare administrative contractors could use to determine whether a person had a medical need for skilled services.
Many have called for this change, including the American Health Care Association/National Center for Assisted Living and the Congressional Commission on Long-Term Care. The commission released its full report to Congress last week, and McDermott said he noted its recommendation to kill the three-day inpatient requirement.
AHCA President and CEO Mark Parkinson praised McDermott for addressing a “long-standing problem.”
Another recently introduced House bill, the HEAR Act, would also change Medicare. Rep. Matt Cartwright (D-PA) and 12 co-sponsors put forward the legislation, which would provide Medicare coverage for hearing aids and hearing rehabilitation services.