By: Linda Fodrini‐Johnson, MA, MFT, CMC
Founder & Chairman, Eldercare Services
Did you have a parent taken to the ER recently and then admitted, or so you thought? Since the Affordable Care Act and the “hospital re-admission penalties” to hospitals, more and more hospitals are keeping those patients that fit the penalty categories on “Observation Stay” which means it is covered in the “Outpatient” portion of Medicare and will not qualify the patient even after the 3 day stay for skilled nursing rehab care.
So, if your parent is being kept in the hospital (especially if they have been admitted within the last 90 days) for the same condition, they could be on “observation” and not admitted. They could be at risk for more expenses and less benefits than expected. Ask questions, especially if you think they will need some rehabilitation before going back home and advocate for “admission” over “observation” especially if the cost is going to be an issue in getting the care your parent might need.
The Solution to the Problem
There is a bill pending in Congress, the Improving Access to Medicare Coverage Act of 2013, (H.R. 1179) introduced by Joe Courtney (D-CT) and Tom Latham (R-IA), that would classify outpatient/observation services as inpatient services for purposes of meeting the three night hospital stay requirement for Part A coverage of hospital and post-hospital skilled care. This bill is a bi-partisan effort, supported by 106 Representatives and 24 Senators and many national organizations. It did not pass during the 2014 Session of Congress; however, sponsors have reintroduced this bill in the 2015 Congressional Session. Individuals with disabilities, their family members and advocates should encourage their legislators to support this legislation.
For more information, please refer to the recent Wall Street Journal Business Section article, “Medicare Rules Reshape Hospital Admissions” – http://on.wsj.com/1XFCHGP or contact a Professional Care Manager/Aging Life Professional at www.EldercareAnswers.com.
