Provider groups lobby for Medicare observation stay fix

Long-term care provider groups said at a congressional briefing Thursday that they want a Medicare policy on observation stays in hospitals to be changed.  

Under existing rules, in order to have skilled nursing care after a hospitalization, a Medicare beneficiary must be considered a hospital inpatient. If the patient is admitted for an observation stay, Medicare can deny coverage.

“Patients are confused and don't understand why there is a possibility of not receiving appropriate and necessary skilled nursing care,” Gail Sheridan, an American Health Care Association representative, told lawmakers. “Patients and their families deserve clarity and peace of mind that they can get the quality skilled nursing care they need.”

A bipartisan group of lawmakers introduced the Improving Access to Medicare Coverage Act of 2011 last April in a move to correct this rule. The legislation would adjust the Social Security Act so that seniors' time spent under observation status at a hospital would satisfy the three-day stay skilled nursing requirement for Medicare coverage.

Other groups represented at the briefing include the American Medical Directors Association, LeadingAge, AHCA and AARP among others.