Observation vs. Admission Status for Seniors upon Hospitalization: Know before you go
Problem
Federal regulations have changed the hospital admission procedure for Medicare recipients. Hospitals are required to admit Medicare patients under the “observation” status while patients receive full medical treatment in a hospital bed. This status can be longer than 48 hours and generally without the patient’s knowledge.
What this means to you
• Medicare recipients are billed for 20% co-payments and full prescription costs when admitted to a hospital under “observation.” More money out of your pocket to pay for hospital care that should be covered by Medicare Part A.
• Medicare will not cover a skilled nursing facility (SNF) if there is less than three consecutive days of inpatient care (not counting the date of discharge). You will be responsible for the cost of a SNF, with an average cost of $350/day.
• Medicare has increasingly denied admission for inpatient status.
• You lose your right to appeal Medicare denials.
Solution – Passage of proposed US Legislation: S. 818 and H.R. 1543, the “Improving Access to Medicare Coverage Act of 2011.”
• Amends the Medicare statute’s definition of “post-hospital extended care services” to include observation status as inpatient in the hospital, thereby covered under Part A.
• Alleviate the problem of shifting costs to the beneficiary and hospital.
• Prevents poor care and frequent readmissions.
• Retroactive beginning January 1, 2011 but beneficiaries must appeal within 90 of enactment.
Action
Contact and demand that the CT delegation co-sign the bills and request them to persuade other state delegations to do the same. (Contact information on back).
Congressman Joseph Courtney (Sponsor of HR.1543)
Washington Norwich Enfield
202-225-2076 860-886-0139 860-741-6011
Web courtney.house.gov/
Congresswoman Rosa L. DeLauro
Washington New Haven Middletown Naugatuck Derby
202-225-3661 203-562-3718 860-344-1159 203-729-0204 203-735-5005
Web delauro.house.gov/
Congressman Christopher Murphy
Washington New Britain Meriden Danbury Waterbury
202-225-4476 860-223-8412 203-630-0815 203-798-2072 203-759-7541
Web chrismurphy.house.gov/
Congressman James Himes
Washington Bridgeport/Stamford
202-225-5541 866-453-0028
Web himes.house.gov/
Congressman John Larson
Washington Hartford
202-225-2265 860-278-8888
Web larson.house.gov/
Senator Joseph Lieberman Senator Richard Blumenthal
Washington Hartford Washington Hartford
202-224-4041 860-549-8463 202-224-2823 860-258-6940
Web lieberman.senate.gov/index.cfm/contact/email Web blumenthal.senate.gov/contact/
Caring Families Coalition is a nonpartisan advocacy coalition that unites groups, families, and individuals, and encourages collective action to improve or protect health care. We provide members with information, trainings and opportunities to advocate for positive change. CFC does not sell health care products or accept money from health care companies.
For more information, please contact:
Eva Csejtey, CFC Organizer Sarahí Almonte, CFC Organizer
860.230.5008 or eva.csejtey@ucanct.org 860.524.0502 or sarahi.almonte@ucanct.org
This information was provided by a panel on Observe Vs. Admit – The New Limbo Land for Hospital Patients with Medicare, sponsored by Senior Resources – Agency on Aging.
