Wednesday, August 17, 2016

Congressman Criticizes CMS of NOTICE Implementation Delay

Rep. Lloyd Doggett (D-TX) (pictured) said the Center for Medicare and Medicaid Services (CMS) “is failing to fulfill its responsibilities” to notify beneficiaries of their eligibility for skilled nursing care following a hospital stay.

Rep. Doggett said the comments after the effects of the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, passed last year, were delayed due to CMS not finalizing a related form. Rep. Doggett was the sponsor of the NOTICE Act before it was passed out of the House unanimously on a voice vote.

Beneficiaries “absolutely deserve to understand their status when they are hospitalized, and to know whether they are losing their eligibility for covered stays at skilled nursing facilities,” the Congressman told Bloomberg BNA last week.

The NOTICE Act requires hospitals to let patients know their status—inpatient or outpatient—during their stay, a distinction which could affect Medicare’s coverage of skilled nursing care following the hospitalization. Patients who do not receive three days of inpatient care at a hospital are not eligible to have Medicare cover a skilled nursing stay after they leave.

The law required that hospitals notify beneficiaries of their status starting August 6th using a CMS-approved form, known as the Medicare Outpatient Observation Notice (MOON). The Office of Management and Budget, however, is still reviewing the form and may not finalize a decision for several months.

The American Health Care Association will work with lawmakers and CMS to ensure proper implementation of laws affecting the 3 day stay and will continue to advocate for a permanent solution for beneficiaries denied Medicare coverage because of this provision.

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