Senators Schumer and Brown Introduce Bill to Eliminate “Observation” Loophole to Care in Nursing Home

senior-observationMany seniors do not realize that they can be sent to a hospital emergency room and kept their overnight or even for several days, and never be classified as admitted to the hospital. Even though the senior was in the hospital, he or she is classified as an “outpatient” for Medicare billing services. This is because the patient is in “observation” status. This is the period of time that the doctor is evaluating whether or not to actually admit the patient to the hospital. Why is this so important?

Under current law, Medicare does not pay for skilled nursing rehabilitation services unless the patient was admitted to the hospital for three days (twenty-four hour periods). Hundreds of thousands of seniors are being denied Medicare coverage for therapy in skilled nursing facilities and rehabilitation hospitals each year because they were never admitted to the hospital (always remained in observation status) or they failed to meet the three day requirement because a portion of their stay was classified as observation.

Senator Charles Schumer (D-NY) and Senator Sherrod Brown (D-OH) have introduced The Improving Access to Medicare Coverage Act of 2013 to close this loophole. Correcting the observation stay loophole has been a major item on the list for SNF advocates for many years. Senator Schumer said the bill would save seniors substantial sums of money and will lessen the burden on health care providers because it will reduce the amount of time they spend determining how a hospital stay should be coded. A similar bill was introduced in both houses of Congress in 2011 and failed to pass. It will be extremely difficult to move this bill forward given the current fiscal stand-off. Those interested in seeing this bill pass should contact their congressmen and tell them you support the Improving Access to Medicare Coverage Act of 2013.

Nursing Homes Say Office of Inspector General’s Report on Poor Care in Skilled Nursing Facility Skews Picture

The Department of Health and Human Services Office of Inspector General (“OIG”) has released a report finding that in 2009 SNFs collected $5.1 million in Medicare payments that did not satisfy government quality standards.

The report states that of the 190 skilled nursing home stays it reviewed, twenty-six percent did not develop a resident care plan that met federal standards. For an additional fifteen percent of the stays, the SNF did not provide services in accordance with the plan.  The reviewers also looked at 83 discharge plans and found that in thirty-one percent of the cases, the discharge plan was inadequate.

The Center for Medicare and Medicaid Services (“CMS”) accepted the OIG recommendations and that CMS increase monitoring and follow-up at underperforming facilities and take further steps to link Medicare payments with quality of care provided.

Nursing home advocates responded that they take the report very seriously but that they wish the OIG report had broadened its focus to look at health outcomes, pointing to an increase in the number of CMS five star facilities since 2009 and the fact that CMS’ own data measuring other quality measures shows health results are trending better, not worse, for skilled nursing facilities since 2009. The group LeadingAge noted the OIG report does not account for important changes implemented since 2009.

Our Riverside elder law firm focuses on putting together a plan for the senior to receive quality care while looking for the most cost efficient means to pay for that care. Your clients can get more information about a complimentary review of their situation at our Riverside law office by calling 951-787-7711 or contacting us online.

Dennis M. Sandoval, A Professional Law Corporation, of Riverside, California, provides representation throughout Riverside, Corona, Norco, Moreno Valley, Eastvale, Jurupa Valley, Mira Loma, Redlands, Ontario, Rancho Cucamonga, Upland, Chino, Chino Hills, San Bernardino, Fontana, Rialto, Colton, Perris, Hemet, Sun City, Temecula, Murrieta, Menifee, Winchester, San Jacinto, Lake Elsinore, Idyllwild, Lake Arrowhead, Crestline, Running Springs, Wrightwood, Yucaipa, Palm Springs and Palm Desert.

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