[Congressional Record (Bound Edition), Volume 159 (2013), Part 10]
[Extensions of Remarks]
[Page 14067]
[From the U.S. Government Publishing Office, www.gpo.gov]




               THE FAIRNESS FOR BENEFICIARIES ACT OF 2013

                                 ______
                                 

                           HON. JIM McDERMOTT

                             of washington

                    in the house of representatives

                      Thursday, September 19, 2013

  Mr. McDERMOTT. Mr. Speaker, I rise today to introduce the Fairness 
for Beneficiaries Act of 2013.
  Before Medicare beneficiaries can access skilled nursing facility 
(``SNF'') care, they must have a preceding three (3) day inpatient stay 
at a hospital. Historically, this made sense. The goal was to ensure 
the use of SNF care was limited to certain circumstances where such 
care was medically necessary. The relatively arbitrary 3-day 
requirement was acceptable; medical developments and technology were 
such that beneficiaries usually would need 3 days of inpatient care 
prior to accessing SNF care.
  I contend that times have changed. First, many Medicare beneficiaries 
are simply not medically appropriate for inpatient stays; they require 
direct admission to a SNF. Thus, the 3 day stay requirement imposes a 
burden--both physical and financial. We know inpatients can often 
acquire healthcare-associated infections (``HAIs'') during their stay 
at a hospital. The potential for beneficiaries who may have compromised 
immune systems to acquire an HAI is substantially higher, compared with 
the rest of the population. One recent estimate projects the annual 
direct cost of HAIs to United States hospitals at $28.4 to $45 billion. 
Some of this financial burden could be avoided potentially if 
beneficiaries could bypass the inpatient setting and go directly to a 
SNF, when a physician certifies that SNF care is appropriate.
  There is another reason that this legislation is of critical 
importance. The use of observation status by physicians has caused a 
substantial burden for patients. Medicare beneficiaries may go to a SNF 
thinking that because they had been sitting in a hospital bed for 3 
days, that their SNF care would be paid for by Medicare--only to find 
that this is not the case because 1 or 2 of the days that they spent at 
the hospital were spent in observation status. Such patients are hit 
with substantial financial liability time and time again when they 
access SNF care. This issue has directly affected my constituents and I 
am seeking to put an end to this problem by eliminating the requirement 
for a 3 day stay prior to beneficiaries accessing SNF care.
  Finally, I recognize that some critics may say there is a substantial 
cost to this legislation and that the cost to the Medicare program is 
simply too great. I believe that some of the cost associated with this 
legislation could be offset. First, as described above, there is a 
potential savings in reducing some HAIs that Medicare beneficiaries 
acquire during the inpatient stay since the beneficiaries can now go 
straight to a SNF when medically indicated. Second, I note that there 
will be a decrease in the use of inpatient hospitals by this population 
when beneficiaries are ready to go straight to a SNF. Third, I note 
that beneficiaries deserve the best care that we can afford to them. As 
such, the right policy in this regard is to allow them to access SNF 
care where medically appropriate as certified by a physician. Finally, 
the legislation contains certain protections to protect against fraud, 
waste and abuse in the Medicare program relative to this benefit. 
First, a physician certification continues to be required prior to a 
beneficiary being able to access SNF services. Second, the legislation 
requires CMS to develop uniform requirements that will allow CMS and 
its contractors to audit to ensure that SNF care is appropriate.
  For all of these reasons, the Fairness for Beneficiaries Act of 2013 
is the right thing to do. I encourage my colleagues to support this 
legislation.

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