Kill inpatient eligibility requirement for skilled care, former CMS chief Berwick says

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The former head of the Centers for Medicare & Medicaid Services has said the agency should scrap a rule requiring three days as a hospital inpatient to qualify for Medicare coverage of skilled nursing care. Long-term care advocates praised the statement.

In a recent interview with the Boston Globe, Donald Berwick, M.D., said he considered eliminating the rule during his tenure as acting administrator. However, other CMS officials worried this would lead beneficiaries to check into nursing homes unnecessarily, he said.

Opposition to the rule has continued to mount since Berwick left CMS in Dec. 2011, fueled by concerns over observation stays. Hospitals have increasingly placed patients in observation status even if they stay longer than three days. These patients are then surprised when they have to foot expensive bills for post-acute therapy. The nation's largest long-term care provider groups, including the American Health Care Association/National Center for Assisted Living, have repeatedly called for a remedy.

“We are encouraged by Dr. Berwick's public comments advocating for more to be done to protect Medicare patients who need access to skilled nursing care,” said AHCA President and CEO Mark Parkinson. “We hope CMS will heed the advice of its former administrator and use its authority to once and for all address the observation stays issue.”

CMS recently issued a new rule intended to reduce the use of observation status, saying that most hospital stays lasting longer than two midnights should be classified as inpatient. AHCA, Berwick and other advocates for change say that more has to be done to completely resolve the problem.

One potential solution would be passage of the Improving Access to Medicare Coverage Act of 2013, which would eliminate the three-day inpatient requirement entirely. CMS is currently analyzing the cost of doing this, according to the Congressman who filed the House bill, Rep. Joe Courtney (D-CT). The bill likely will be added to a larger Medicare reform measure, Courtney told the Globe.