Introduction Of Legislation To End Surprise Bills, Improve Affordability And Outcomes For Medicare Patients

Angie Szumlinski Announcements, News

Representatives Joe Courtney (CT-02), Glenn ‘GT’ Thompson (PA-15), Susan DelBene (WA-01), and Ron Estes (KS-04) re-introduced the bipartisan Improving Access to Medicare Coverage Act of 2021, legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in exorbitant and unexpected out-of-pocket costs. Under current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days for Medicare to cover skilled nursing care. Hospitals are increasingly holding patients under “observation status”—an “outpatient” designation. Under outdated Medicare rules, patients who receive hospital care on “observation status” do not qualify for the benefit of skilled nursing care, even if their hospital stay lasts longer than three days and even if their care team prescribes it…

The Improving Access to Medicare Coverage Act of 2021 would ensure Medicare covers this doctor-recommended, post-acute care even after the pandemic concludes by counting the time spent under “observation status” towards the requisite three-day hospital stay for coverage of skilled nursing care.

– Press Release from United States Congressman Joe Courtney, June 1st 2021

The goal of this legislation is to prevent “surprise” billing, where an individual thinks their care is covered under Medicare and they end up with significantly larger (often, by thousands of dollars) out of pocket costs than expected. The bipartisan bill is endorsed by many different senior care organizations.