14 Feb It’s High Time For Medicare To Dump An Archaic Rule

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text]It’s Time: Repeal the 3-Day Inpatient Hospital Requirement for Medicare Skilled Nursing Facility Coverage Last year, the Center for Medicare Advocacy suggested that it was time to repeal the three-day inpatient hospital requirement that is necessary for Part A coverage in the traditional Medicare program. The recent Second Circuit decision in Barrows v. Becerra, which holds that Medicare beneficiaries have a Constitutional right to appeal when their status is changed from inpatient to observation, has renewed focus on the statutory three-day stay requirement. When Medicare was enacted in 1965, it limited coverage in a skilled nursing facility (SNF) under Part A to beneficiaries who had been inpatients in an acute care hospital for at least three consecutive days before their discharge to a SNF. The benefit, called extended care, was viewed, literally, as a limited extension of a hospital stay. Since the average length of stay in an acute care hospital for a patient aged 65 or older in 1965 was more than 13 days, most hospitalized Medicare beneficiaries had no difficulty satisfying the three-day inpatient requirement. Times have changed. Congress should repeal the three-day inpatient requirement for multiple reasons.[/vc_column_text][vc_empty_space height="25px"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Medical care has changed in the past 55 years. [/vc_column_text][vc_column_text]Many medical procedures, including surgeries, that required inpatient hospital stays for multiple days or weeks in 1965 now require limited hospital stays or may even be done on an outpatient basis. Following these procedures, patients may nevertheless need the skilled nursing or skilled rehabilitation services that a SNF provides. As the Centers for Medicare & Medicaid Services (CMS) acknowledged in 2014, in proposed rules for Accountable Care Organizations (ACOs). Repealing the three-day inpatient hospital requirement reflects the realities of modern medicine.[/vc_column_text][vc_empty_space height="25"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Traditional Medicare and Medicare Advantage need to be aligned. [/vc_column_text][vc_column_text]While the traditional Medicare program retains the three-day requirement, Medicare Advantage (MA) plans are permitted by law to waive the three-day requirement, and most do. At present, approximately 42 percent of Medicare beneficiaries receive their health care through MA plans, either because MA is the only option offered by their former employers or unions as retiree health or because they choose MA. More than 60 percent of all Medicare beneficiaries receive coverage through programs that generally waive the three-day requirement. All Medicare beneficiaries should receive comparable care and services, regardless of how they participate in Medicare.[/vc_column_text][vc_empty_space height="25"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Observation status in hospitals deprives beneficiaries of Medicare SNF benefits and necessary care. [/vc_column_text][vc_column_text]Over the last 20 years, under pressure from CMS, acute care hospitals have increasingly described patients as receiving care in observation stays, covered by Medicare Part B rather than by Part A. What CMS labels “observation services” are provided to patients in “outpatient” status, which does not qualify patients for Part A SNF coverage, even though the care and services that observation patients receive may be indistinguishable from the care and services received by inpatients and even when...