Policy Alert: Medicare Beneficiary Requirements

Rep. Joe Courtney (D-CT) has introduced H.R. 1571, to require all times a Medicare beneficiary spends in the hospital to be counted toward the three-day stay requirement. The bill has 55 bipartisan cosponsors. The comparable Senate bill is S. 843, introduced by Sen. Sherrod Brown (D-OH), with 10 cosponsors, also bipartisan.

The House also has passed H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility, or NOTICE Act. The bill requires hospitals that hold any Medicare beneficiaries for longer than 24 hours under observation to provide the beneficiaries with oral and written notification of their outpatient status and its potential implications for eligibility for Medicare coverage of subsequent post-acute care.

“These two seemingly contradictory bills are causing a lot of confusion among Medicare beneficiaries who think that because they or their loved one was in the hospital for three days they are covered under Medicare Part A,” says Toni Lynn Davis, Executive Director and President of Green Hill Inc.  “Patients find out they were technically ‘under observation’ for more than one day and do not qualify for Medicare coverage, requiring them to pay the costs privately. At an average of $390 a day this can be a very startling realization. Many patients will not stay for observation or therapy but will return home because they cannot afford to pay these out of pocket fees. This legislation will create additional health care issues and costs as the elder at home is not getting the care they need, not moving about, often getting worse, which often requires a return to the hospital for a longer duration and at greater expense for the hospital”.