The Improving Access to Medicare Coverage Act Reintroduced

Reps. Joe Courtney (D-CT), Glenn ‘GT' Thompson (R-PA), Susan DelBene (D-WA), and Ron Estes (R-KS reintroduced the bipartisan Improving Access to Medicare Coverage Act of 2023 (HR 5138), legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in excessive and unexpected out-of-pocket costs. Under current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days for Medicare to cover skilled nursing care. Hospitals increasingly hold patients under “observation status”—an “outpatient” designation. Under outdated Medicare rules, patients who receive hospital care on “observation status” do not qualify for the benefit of skilled nursing care, even if their hospital stay lasts longer than three days and their care team prescribes it. These patients are either forced to return home without the treatment they have been prescribed or, as often happens, are unexpectedly billed astronomical amounts after their stays in a skilled nursing facility (SNF). These patients can quickly accrue tens of thousands of dollars in SNF bills, and recent research suggests that this policy most impacts those who can least afford it.

During the COVID-19 Public Health Emergency, 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 of 2023 would ensure Medicare covers doctor-recommended, post-acute care by counting the time spent under “observation status” toward the requisite three-day hospital stay for coverage of skilled nursing care.

The Society and many other national organizations continue to support the legislation.

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