Tuesday, September 10, 2019

Congressional Letter to Heads of CMS and HHS on 3-Day Stay Requirement and Observation Stays Issue

Dana Halvorson

Last week, U.S. House of Representative Members, Joe Courtney (D-CT) and Glenn ‘GT’ Thompson (R-PA), wrote to the Secretary of Health and Human Services (HHS), the Honorable Alex Azar, and to the Administrator of the Centers for Medicare and Medicaid Services (CMS), the Honorable Seema Verma, on the three-day stay requirement and observation stays issue.  In the letter, Reps. Courtney and Thompson specifically noted to the agency heads, “This year, we ask if you intend to use your authority to once and for all remove this inequitable, longstanding, and bureaucratic barrier to care.”

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 “Skilled Nursing Facility 3-day rule”).  Each year numerous beneficiaries are unable to access their skilled nursing benefit because of the administrative classification of their hospital stay, even if the stay is deemed medically necessary, and even if the stay spans three days or more.  AHCA/NCAL has also urged CMS to take action and eliminate this confusing policy barrier by recognizing observation stays as qualifying stays for the purposes of the three-day stay requirement.  For more information about this issue, be sure to visit the AHCA/NCAL website.

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