“Under the proposed rule, Medicare would presume that an individual is an inpatient if the physician documents that the patient requires more than two midnights in the hospital following an inpatient admission. The ‘starting point for this time-based instruction would be when the beneficiary is moved from any outpatient area to a bed in the hospital in which the additional hospital services will be provided.’ 78 Federal Register at 27648.”
This is the second of two proposed rules from CMS involving observation stays in four months. Currently, a three-day in-patient hospital stay is required for patients to be admitted to a skilled nursing facility under Medicare Part A.
CMS has acknowledged that the current process for dealing with observation stays is problematic and generally unsustainable.
AHCA feels that the only and best way to provide Medicare-covered post-acute access to beneficiaries is for CMS to count ALL days in observation toward the 3-day stay requirement. AHCA believes that CMS has both the authority and obligation to change policy on whether time spent in observation status is considered when determining eligibility for skilled nursing facility coverage.