[Congressional Record Volume 157, Number 55 (Thursday, April 14, 2011)]
[Extensions of Remarks]
[Page E718]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     INTRODUCTION OF THE IMPROVING ACCESS TO MEDICARE COVERAGE ACT

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                           HON. JOE COURTNEY

                             of connecticut

                    in the house of representatives

                        Thursday, April 14, 2011

  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excluded from this coverage because of an outdated and unfair CMS 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.

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