Wednesday, June 21, 2017

25 National Organizations Sign Letter to CMS on the Observation Stays Matter

Dana Halvorson and James Michel

On June 20, 2017, 25 organizations, including AHCA/NCAL, submitted a comment letter to the Centers for Medicare & Medicaid Services outlining a regulatory fix relating to the observation stays matter.  The organizations that signed the letter are members of a broad coalition of beneficiary and provider advocacy groups who are dedicated to preserving Medicare beneficiaries’ access to necessary skilled nursing care following a hospital stay, regardless of whether that stay was classified as inpatient or outpatient observation.  Under current law, a Medicare beneficiary must spend at least three days as a hospital inpatient for Medicare to cover a subsequent stay in a skilled nursing center (known as the “SNF 3-day rule”).

AHCA/NCAL continues to keep the observation stays issue one of its top advocacy and outreach priorities.  Increasingly, patients have no idea what their status is in a hospital, or the importance of it, which can lead to thousands of dollars in out-of-pocket medical expenses should they need skilled nursing center care following their hospital stay.  In addition to placing a financial burden on seniors and their families, this anomaly in Medicare rules can cause unnecessary spend-down, accelerating the time frame in which seniors will have to turn to programs such as Medicaid to pay for their care.  For more information about the observation stays issue, please visit the AHCA/NCAL website.

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