Press Releases

Today, Representatives Suzan DelBene (WA-01), Joe Courtney (CT-02), Glenn ‘GT' Thompson (PA-15), and Ron Estes (KS-04) reintroduced the bipartisan Improving Access to Medicare Coverage Act, legislation that would fix an arbitrary Medicare policy that excludes certain patients from skilled nursing care coverage, resulting in exorbitant and unexpected out-of-pocket costs. 

Currently, a patient 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 Under this outdated rule, patients who receive hospital care under this status do not qualify for skilled nursing care, even if their hospital stay lasts longer than three days and even if their care team prescribes it. These patients are either forced to return home without the treatment they have been prescribed or are unexpectedly billed astronomical amounts after their stays in a skilled nursing facility (SNF). These patients can easily accrue tens of thousands of dollars in unexpected medical bills, and recent research suggests that this policy most impacts those who can least afford it.

“With health care already a significant expense for seniors, the last thing they need is an expensive and unexpected medical bill. When a Medicare patient is in the hospital for three days, that should meet the three-day requirement. Plain and simple,” said DelBene. “Differentiating between ‘inpatient’ and ‘observation’ is what frustrates people about the health care system. This legislation would make clear that three days means three days, allowing seniors to access rehabilitation services they need to get better and not incur a massive unexpected medical bill.”

“People deserve better. Whether a patient is in the hospital for three days as an inpatient, or for three days under ‘observation status'—three days is three days. Quibbling over semantics shouldn't keep people from accessing the care their doctors have prescribed or trap them beneath a mountain of unexpected medical debt. Our bill offers a simple, commonsense fix to Medicare's arbitrary ‘observation status' loophole that will help ensure seniors aren't getting billed thousands of extra dollars in medical bills due to illogical federal policy,” said Courtney.  

“When facing health challenges, seniors and their families shouldn’t be burdened by unexpected medical expenses,” said Thompson. “Medicare beneficiaries deserve the reassurance and confidence that their care will be fully covered and they won't have any out-of-pocket costs.” 

“Kansas seniors on Medicare deserve access to the full range of treatment and care they need, unimpeded by outdated policies that result in costly bills," said Estes. "This common sense legislation updates Medicare’s policy on skilled nursing care to make it more efficient and lead to better outcomes for patients.” 

During COVID-19, the three-day requirement was waived, allowing patients to receive SNF care regardless of their hospital status. Now, the policy is being reimposed on beneficiaries, causing confusion, unexpected bills, and delays in care. 

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

“This bipartisan bill will help fix an outdated policy that continues to leave millions of Medicare beneficiaries surprised by thousands of dollars in medical bills and hanging with uncertainty regarding their access to the Medicare coverage they deserve,” said Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living. “The members of Congress that reintroduced this important legislation are advocates for our nation’s seniors and individuals who need skilled nursing care. We applaud their efforts and support.”

Endorsing Organizations: AARP; ADVION (formerly National Association for the Support of Long Term Care); Aging Life Care Association®; Alliance for Retired Americans; AMDA – The Society for Post-Acute and Long-Term Care Medicine; American Association of Healthcare Administrative Management (AAHAM); American Association of Post-Acute Care Nursing (AAPACN); American Case Management Association (ACMA); American College of Emergency Physicians (ACEP); American College of Physician Advisors (ACPA); American Geriatrics Society (AGS); American Health Care Association (AHCA); American Medical Association; American Physical Therapy Association (APTA); Association of Jewish Aging Services (AJAS); Catholic Health Association of the United States (CHA); Center for Medicare Advocacy; The Hartford Institute for Geriatric Nursing; The Jewish Federations of North America; Justice in Aging; LeadingAge; Lutheran Services in America; Medicare Rights Center; National Academy of Elder Law Attorneys, Inc.(NAELA); National Association of Benefits and Insurance Professionals (NABIP); National Association for State Long-Term Care Ombudsman Programs (NASOP); National Center for Assisted Living (NCAL); National Committee to Preserve Social Security & Medicare; The National Consumer Voice for Quality Long-Term Care; National Council on Aging (NCOA); NJHSA – the Network of Jewish Human; Service Agencies; Society of Hospital Medicine (SHM); Special Needs Alliance; USAging.