Senators Kerry and Snowe, with Representatives Courtney and Latham, Introduce Legislation to Ensure Skilled Care for Seniors

Improving Access to Medicare Coverage Act of 2011
Section by Section Summary
Sen. John F. Kerry & Sen. Olympia Snowe

Section 1:  Short Title—”Improving Access to Medicare Coverage Act of 2011″.

Section 2:  Counting a Period of Receipt of Outpatient Observation Services in a Hospital towards the 3-Day Inpatient Hospital Requirement for Coverage of Skilled Nursing Facility Services under Medicare

  1. Currently, Medicare will only cover post-acute care in a skilled nursing facility if a beneficiary has three consecutive days of hospitalization as an inpatient, not counting the day of discharge.  Hospitals are increasing serving Medicare beneficiaries on “outpatient observation status” rather than admitting them as an inpatient—a billing technicality.  Because of this, patients are enduring lengthier hospital stays in observation status and may unknowingly be treated under outpatient observation status for the entirety of their hospital visit.  Under the Act, observation stays will be counted toward the 3-day mandatory inpatient stay for Medicare coverage of SNF services.

The Act applies to outpatient observation services furnished on or after January 1, 2011.  It provides a special transition period for post-acute SNF care that began prior to the enactment of this Act, if an administrative appeal is filed within 90 days of enactment. This provision will allow the Secretary of Health and Human Services to implement the Act through an interim final regulation, program instruction, or otherwise.

Read a PDF copy of the full bill here.