10.17.16

Peters Cosponsors Bill to Prevent Unexpected Costs for Seniors’ Nursing Home Care

WASHINGTON, DC –U.S. Senator Gary Peters (MI) today announced that he has cosponsored bipartisan legislation that will ensure Medicare coverage for skilled nursing care and prevent seniors from incurring large, unexpected medical costs. Currently, a Medicare beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to pay for post-hospitalization skilled nursing care. Patients that receive hospital care on “observation status” are left to pay for skilled nursing care, even if their hospitalization lasts longer than three days.

“Whether a hospital stay is designated as inpatient or outpatient, Michigan seniors deserve access to the quality, affordable healthcare needed to help them recover from illness or injury,” said Senator Peters. “I’m proud to support this bipartisan bill to fix current law and ensure the classification of a hospital stay does not increase the tab for Medicare beneficiaries needing specialized care in a nursing home facility.” 

“Too many Michigan seniors are hit with unexpected, high out-of-pockets costs when they need rehab at a skilled nursing facility following a hospital stay,” said Paula D. Cunningham, AARP Michigan State Director. “We thank Senator Peters for his support of this legislation that would change Medicare rules and help patients get the care they need without the unnecessarily high costs.”

The Improving Access to Medicare Coverage Act would allow patients’ time under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care and establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2015.

According to the Centers for Medicare and Medicaid Services (CMS), outpatient classification is intended for providers to run tests and evaluate patients in order to arrive at appropriate diagnoses and treatment plans, or to provide brief episodes of treatment. Typical services that are not considered “inpatient” involve emergency department services, outpatient surgery, lab testing, or x-rays. For the purposes of counting inpatient days, CMS considers a person an “inpatient” on the first day that the patient is formally admitted to the hospital because of a doctor’s order, and the last is the day before discharge.

 

There are approximately 1.8 million Michigan seniors enrolled in Medicare. This legislation enjoys broad support from health care and retirement organizations, including the American Health Care Association, the Center for Medicare Advocacy, AARP the National Retiree Legislative Network, and the National Chrysler Retirement Organization.

 

Last year, Peters introduced bipartisan legislation with Republican Senator Cory Gardner (CO) that would expand access to health care in rural areas by paving the way for Medicare to cover additional telehealth services. Earlier this year, Peters also introduced the Preventing Diabetes in Medicare Act to improve health outcomes for individuals at risk for diabetes and save long-term care costs for Medicare.

 

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