Notice of Observation Treatment and Implication for Care Eligibility Act

Floor Speech

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Mr. COURTNEY. Mr. Speaker, I want to, first of all, salute
Congressman Doggett for his effort in terms of bringing this
legislation forward. As the chairman of the committee said, this is
really about giving patients a fighting chance to challenge this
coding, a change that happens while people are in the hospital and have
absolutely no idea that they are not being treated as full part A
inpatient patients at hospital facilities.

The impact of being coded as observation versus inpatient may sound
extremely arcane, but what that means is that at time of discharge, if
a patient is medically prescribed to go to a nursing home for rehab
care for a broken bone or for home health services for a heart
condition, they are not covered by Medicare if they are in the
observation bucket as opposed to the inpatient bucket.

The inspector general's office for Medicare issued a report in 2012
that 600,000 patients across the country with long-stay hospital visits
over 3 days fell into this black hole, this no man's land where, again,
their doctors are telling them that they need to have rehab services so
that people can walk again and deal with activities of daily living;
but the price for doing that, because you are in observation status,
can be tens of thousands of dollars, which is where long-term care
facilities, nursing home coverage for private-pay patients, out-of-
pocket patients, exist today.

This bill at least gives patients the opportunity to challenge that
decision. But the fact of the matter is, what we need to do is to
restore the 3-day rule, which is in statute. It has been there since
1965. Observation status is something new within the last 10 years, and
what we need to do as a Congress is to restore that 3-day rule, which
says to a patient: If you are coded observation or if you are coded
inpatient, it should not interfere with your medically prescribed
course of treatment at the time that you are discharged from the
hospital.

That, unfortunately, is not going to be fixed as a result of this
legislation. We should build on this legislation and again restore
Medicare's promise, which, again, from day one, has said that medically
prescribed care will be covered by the system at time of discharge from
a hospital for longer than 3 days.

The horror stories of people who in some instances were in hospital
for 9 days with broken bones, broken hips, who, again, are staring at a
10 to $15,000 fee to be admitted to a nursing home--again, 600,000
cases in 2012.

So again, we need to build on this legislation, but fundamentally, we
need to restore the 3-day rule which has been in statute since 1965. We
will be introducing that legislation later this week. It will be a
bipartisan bill. We think we can withstand the test of any pay-fors to
make sure that it allows the Medicare system's finances to stay in a
stable condition. In the meantime, we should pass this legislation
today.

Again, I want to salute the Member from Texas for his leadership on
this issue.

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