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TOLEDO, OH (Toledo News Now) -
On Tuesday at the Lutheran Home at Toledo, U.S. Sen. Sherrod Brown announced a plan that would end an arbitrary Medicare policy causing senior citizens to be unknowingly hit with large, unfair costs after receiving necessary post-acute medical care. Under current Medicare policy, a beneficiary must have an "inpatient" hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care on "observation status" do not qualify for this benefit, even if their hospital stay lasts longer than three days.
"When seniors are transferred from a hospital to a nursing home for further care, they should be able to focus on their recovery instead of technicalities that could lead to sky high medical bills," Brown said. "My bipartisan legislation would help ensure that seniors receive the care they need without incurring unexpected and unfair costs."
Brown's bill, the Improving Access to Medicare Coverage Act, would allow for the time patients spend in the hospital under "observation status" to count toward the requisite three-day hospital stay for coverage of skilled nursing care.
Specifically, Brown's bill would:
-Amend Medicare law to count a beneficiary's time spent in the hospital on "observation status" towards the three-day hospital stay requirement for skilled nursing care.
-Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2013.
According to the Centers for Medicare and Medicaid Services, outpatient classification is intended for providers to run tests and evaluate patients in order to arrive at appropriate diagnoses and treatment plans, or to provide brief episodes of treatment. Typical services that are not considered "inpatient" involve emergency department services, outpatient surgery, lab testing, or X-rays. For the purposes of counting inpatient days, CMS considers a person an "inpatient" on the first day the patient is formally admitted to the hospital because of a doctor's order; the last is the day before discharge.
Joining Brown to help discuss the issue and the importance of passing legislation was Diana Peth, the daughter of Julia Matthews, a resident at the Lutheran Home at Toledo. On two occasions, Matthews needed multiple-day stays in the hospital for serious conditions that required subsequent skilled nursing care. In both cases, she was under "observation status," and was therefore not eligible for Medicare coverage of her post-hospital stay care.
"The first bill was $18,000 the first month. Then the second was $31,000," said Peth. "She was not able to use her hands to feed herself. She couldn't get out of her chair. She couldn't walk. She couldn't stand."
Doctors determined Matthews could not go home because she needed more medical care to get back to full strength, but something stood in the way of having that additional care covered by her insurance: Matthews was never technically admitted. The hospital listed her as "under observation" so they could run more tests.
Brown says the observation status saves hospitals and Medicare money, while still allowing them to give care. However, it is a technical loophole leaving big bills for families to pay.
"Where's the money going to come from? You know? She's on a fixed income. She has a little tiny pension and social security and she has no way of having $31,000 or $12,000," said Peth.
David Roberts, CEO of the Lutheran Homes Society, also joined the event.
"We are thankful that Sen. Brown chose Lutheran Home at Toledo to hold this press conference to announce his bill, ‘Improving Access to Medicare Coverage Act,' that will address some of the expense issues that face Medicare recipients," Roberts said. "On behalf of Medicare recipients, we are grateful for the senator's insightful vision and addressing this expense burden potentially faced by all Medicare beneficiaries. I am personally blessed to get to know the senator and am aware of his passion to address the needs of seniors."
The Improving Access to Medicare Coverage Act is endorsed by the following:
-American Association of Retired Persons
-American Medical Association
-American Health Care Association
-Center for Medicare Advocacy
-American Case Managers Association
-American Medical Directors Association
-American Nurses Association
-National Association of Professional Geriatric Care Managers
-National Committee to Preserve Social Security and Medicare