A years-long court battle over one of the recent biggest thorns in skilled nursing’s side may finally be going to trial, and the outcome could have big implications for providers and patients alike.
The dispute relates to a group of individuals who were forced to pay out of pocket for their SNF care because Medicare would not cover them. That’s because their hospital stays were classified under observation status; individuals are required to spend three consecutive days as a hospital inpatient before they’re
covered.
The Department Health and Human Services did not adequately prove that patients had no right to a hearing before they were discharged to determine their hospitalization status, Connecticut District Court Judge Michael P. Shea ruled in April. He said he was denying the agency’s request for summary judgment and to decertify the complaint’s class action status.
The Center for Medicare Advocacy, which represents the patients, applauded the court’s decision.
“People who have paid into Medicare their whole lives, and who risk having to pay thousands of dollars for necessary medical care, deserve a fair process to determine whether they will receive Medicare coverage,” said Alice Bers, lead attorney for the CMA, which has been joined in the fight by Justice in Aging.
They noted that, while observation status is often indistinguishable from inpatient care, it does not count toward the three-day requirement. This often leaves beneficiaries with the burden of either paying for or forgoing costly care. One plaintiff, a 93-year-old veteran, had to pay $10,000 for SNF care after being hospitalized for five days with a shoulder fracture.
Shea concluded that the lawsuit, now approaching its eighth year, must proceed to trial without delay. n
From the May 1, 2019 Issue of McKnight's Long-Term Care News
