AMDA Briefs Congress on Observation Stays

Abstract

On Oct. 20, Eric Tangalos, MD, CMD, of the Mayo Clinic in Rochester, Minn., told a congressional briefing that observation time in a hospital should count toward the 3-day inpatient eligibility requirement for coverage of skilled nursing facility services under Medicare. “AMDA has been an advocate to eliminate the mandatory 3-day hospital requirement in order to qualify for post-hospital extended care service payments since my freshman days as AMDA's delegate to the American Medical Association [AMA],” Dr. Tangalos said at the session on Capitol Hill. “We made this an AMDA priority in 1991 and have been working with the AMA since 1993 to provide skilled services to nursing home patients without [their] first having to be admitted to the hospital,” he said. “We now have the opportunity with congressional legislation to at least allow the time patients spend in hospital ‘observation’ to count toward the 3-day qualifying stay.” Medicare beneficiaries spoke during the first half of the briefing. Dr. Tangalos spoke on the second panel with Gail Sheridan, vice president of health care services at Minnesota-based Tealwood Care Centers, who spoke on behalf of the American Health Care Association. She said that patients in observation may not realize it, nor do they know that being in observation can preclude them from getting appropriate nursing home care. Patients and their families deserve clarity in this, Ms. Sheridan said. Dr. Tangalos recounted that AMDA's House of Delegates passed a position affirming its opposition to the Medicare 3-day acute care hospitalization requirement for SNF eligibility in 1993. This AMDA position was later passed as policy by the AMA House of Delegates. In 2008, AMDA expanded its policy to urge the CMS to allow observation-bed and emergency room observation times as counting toward the 3-day-stay requirement. In August 2010, AMDA was represented at the Centers for Medicare & Medicaid Services Listening Session regarding the trends of Medicare beneficiaries receiving extended observation care as hospital outpatients. In written comments to the agency, AMDA urged the CMS to include observation-bed status and emergency room observation time as part of the mandatory 3-day inpatient hospital stay required for the Medicare SNF benefit. AMDA strongly supports the pending legislation Improving Access to Medicare Coverage Act of 2011 (H.R. 1543 & S.818). The bill was introduced in the House of Representatives in April by Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) and in the Senate by John Kerry (D-Mass.) and Olympia Snowe (R-Maine). This bipartisan bill would allow observation time in a hospital to count toward satisfying the 3-day inpatient requirement for SNF-services coverage by Medicare. In addition to AMDA and the American Health Care Association, the Center for Medicare Advocacy, AARP, LeadingAge, the AMA, and the National Committee to Preserve Social Security and Medicare, which also participated in the congressional briefing, support the legislation. Heather Boyd is a member of the government affairs staff at AMDA.