Introduction of the Improving Access to Medicare Coverage Act

Floor Speech

* Mr. COURTNEY. Mr. Speaker, today I am reintroducing legislation to improve a component of our Medicare program that has left many without coverage of needed services and guaranteed benefits. My legislation, the Improving Access to Medicare Coverage Act, will allow time spent on hospital observation status to count towards a three-day qualifying hospital stay requirement for skilled nursing care services. Under current regulations established by the Centers for Medicare and Medicaid Services (CMS), only those that have received an inpatient designation and have a hospital stay of at least three days, qualify for Medicare coverage of skilled nursing care. Those on observation status, which is often indistinguishable from inpatient care, are excluded from this coverage because of an outdated and unfair CMS policy.

* Our systems of care have changed, and so should our Medicare policies. This point has been reiterated in cases heard by administrative law judges involving Medicare coverage of skilled care and observation status designations. Many of these cases have supported the notion that Medicare should cover skilled nursing care, regardless if the patient's qualifying hospital stay is as an inpatient or on observation status. While administrative law judges have often supported patients in these cases, the CMS policy creates a system with arbitrary winners and losers, based on access to legal appeals. My legislation will fix this broken system.

* The Improving Access to Medicare Coverage Act will count time spent in hospital observation status towards the three-day hospital stay requirement for skilled nursing care. My bill will also establish a 90-day appeals period following passage for those that have been denied coverage after January 1, 2011 due to this CMS policy. The appeals process will allow those that have a qualifying hospital stay--either as an inpatient or on observation status--after January 1, 2011 to be eligible for skilled nursing care. While I believe that the legislative text clarifies that the appeals process is available to any Medicare beneficiary that has been denied coverage after January 1, 2011 due to this policy, there should be no doubt as to my congressional intent. It is my intent that any individual, regardless of whether an initial appeals process has expired, can appeal during the 90-day window following passage so long as their hospital stay and subsequent denial of skilled care occurred after January 1, 2011.

* I also want to thank the Center for Medicare Advocacy for bringing to light the impact of this broken policy. I look forward to working with the Center and the other organizations that have expressed their support of this legislation to bring resolution to this issue that has negatively impacted many of my constituents, and patients and families across the country, for far too long.

Source