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House|Senate

114th Congress, Vote 115; House of Representatives #876

NOTICE Act


Official Title: To amend title XVIII of the Social Security Act to require hospitals to provide certain notifications to individuals classified by such hospitals under observation status rather than admitted as inpatients of such hospitals.

HR 876: Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)
Passed by the House March 16, 2015, 229-166 (37 abstaining).

Synopsis: Under HR 876, hospitals would have to notify Medicare patients of their admission status. When patients are in the hospital, they are sometimes kept under outpatient observation as opposed to being considered inpatients. The distinction is crucial in terms of how Medicare benefits are structured, as Medicare provides coverage under two separate parts – A and B – depending on whether the care is inpatient or outpatient.

In addition, Medicare coverage in a skilled nursing facility is only covered if the beneficiary has spent three inpatient days in the hospital prior to entering the skilled nursing facility. Time spent in the hospital under observation as an outpatient does not count towards those three days, but again, patients aren?t always aware of the distinction - to most patients, a day in the hospital is a day in the hospital, unless they?re notified otherwise.

If a Medicare beneficiary receives hospital care as an outpatient under observation for more than 24 hours, HR 876 would require the hospital to notify the patient that the care is considered outpatient, that outpatient cost-sharing will apply, and that the time under observation will not count towards the three inpatient days required to be eligible for skilled nursing facility services following discharge from the hospital.

The notice would have to be given to the patient within 12 hours of crossing the 24 hours in hospital threshold (ie, within 36 hours of entering the hospital).

Why supporters pushed for this bill

  • HR 876 would bring more transparency to Medicare billing, as patients would be aware of their admission status within 36 hours of entering the hospital.
  • The American Health Care Association supports HR 876, and explains that the legislation will help prevent surprise skilled nursing facility bills for Medicare patients. Patients who thought that they had three inpatient days – but who actually had "outpatient observation" time in the hospital – sometimes go on to a skilled nursing facility, expecting the bill to be covered. Without proper notification of their admission status in the hospital, those patients might not be aware that their SNF care isn?t covered, until they get the bill.
  • The Congressional Budget Office noted that there would have no "significant budgetary effects over the 2015-2025 period."

Why opponents tried to stop the bill

  • The American Hospital Association expressed reservations about HR 876. They supported the general idea of making patients aware of their admission status in the hospital, but were worried that the language of HR 876 would be overly onerous for hospitals.
  • The concern was that HR 876 doesn?t provide enough leeway for hospital compliance in situations that are outside the hospital's control – for example, when admission status is retroactively changed, or when the patient is unable to sign off on the notification statement and no patient representative is available to sign.
  • There is also concern that hospitals might not have access to the level of cost-sharing detail required under HR 876. Although there's widespread support for the idea of making sure that patients are aware that their admission status plays a role in their cost-sharing requirements and their eligibility for subsequent skilled nursing facility care, hospital advocates would prefer to see more general patient notification forms regarding cost-sharing and SNF eligibility, rather than specific details.
03/16/2015 Status: House passed

More: select a member to see his or her other key Medicare votes.

Yes (395)
R Don Young AK
R Robert Aderholt AL
R Mo Brooks AL
R Bradley Byrne AL
R Gary Palmer AL
R Martha Roby AL
R Mike Rogers AL
D Terri Sewell AL
R Eric Crawford AR
R French Hill AR
R Bruce Westerman AR
R Steve Womack AR
R Trent Franks AZ
D Ruben Gallego AZ
R Paul Gosar AZ
D Ann Kirkpatrick AZ
R Martha McSally AZ
R Matt Salmon AZ
R David Schweikert AZ
D Kyrsten Sinema AZ
D Pete Aguilar CA
D Karen Bass CA
D Ami Bera CA
D Julia Brownley CA
R Ken Calvert CA
D Lois Capps CA
D Tony Cárdenas CA
D Judy Chu CA
R Paul Cook CA
D Jim Costa CA
D Susan Davis CA
R Jeff Denham CA
D Mark DeSaulnier CA
D Anna Eshoo CA
D Sam Farr CA
D John Garamendi CA
D Janice Hahn CA
D Michael Honda CA
D Jared Huffman CA
R Duncan Hunter CA
R Darrell Issa CA
R Steve Knight CA
R Doug LaMalfa CA
D Barbara Lee CA
D Ted Lieu CA
D Zoe Lofgren CA
D Alan Lowenthal CA
D Doris Matsui CA
R Kevin McCarthy CA
R Tom McClintock CA
D Jerry McNerney CA
D Grace Napolitano CA
R Devin Nunes CA
D Nancy Pelosi CA
D Scott Peters CA
D L. Roybal-Allard CA
R Edward Royce CA
D Raul Ruiz CA
D Linda Sánchez CA
D Adam Schiff CA
D Brad Sherman CA
D Eric Swalwell CA
D Mark Takano CA
D Mike Thompson CA
D Norma Torres CA
R David Valadao CA
D Juan Vargas CA
R Mimi Walters CA
R Ken Buck CO
R Mike Coffman CO
D Diana DeGette CO
R Doug Lamborn CO
D Ed Perlmutter CO
D Jared Polis CO
R Scott Tipton CO
D Joe Courtney CT
D Rosa DeLauro CT
D Elizabeth Esty CT
D James Himes CT
D John Larson CT
R Gus Bilirakis FL
D Corrine Brown FL
R Vern Buchanan FL
D Kathy Castor FL
R Curtis Clawson FL
R Ander Crenshaw FL
R Carlos Curbelo FL
R Ron DeSantis FL
D Theodore Deutch FL
R Mario Diaz-Balart FL
D Lois Frankel FL
D Gwen Graham FL
D Alan Grayson FL
D Alcee Hastings FL
R David Jolly FL
R John Mica FL
R Jeff Miller FL
D Patrick Murphy FL
R Richard Nugent FL
R Thomas Rooney FL
R Ileana Ros-Lehtinen FL
R Dennis Ross FL
D D. Wasserman Schultz FL
R Daniel Webster FL
D Frederica Wilson FL
R Ted Yoho FL
R Rick Allen GA
D Sanford Bishop GA
R Buddy Carter GA
R Doug Collins GA
R Tom Graves GA
R Jody Hice GA
D Henry Johnson GA
D John Lewis GA
R Barry Loudermilk GA
R Tom Price GA
R Lynn Westmoreland GA
R Rob Woodall GA
D Tulsi Gabbard HI
D Mark Takai HI
R Rod Blum IA
R Steve King IA
D David Loebsack IA
R David Young IA
R Raúl Labrador ID
R Michael Simpson ID
R Mike Bost IL
D Cheri Bustos IL
D Danny Davis IL
R Rodney Davis IL
R Bob Dold IL
D Tammy Duckworth IL
D Bill Foster IL
R Randy Hultgren IL
D Robin Kelly IL
R Adam Kinzinger IL
D Mike Quigley IL
D Janice Schakowsky IL
R Aaron Schock IL
R John Shimkus IL
R Susan Brooks IN
R Larry Bucshon IN
D André Carson IN
R Luke Messer IN
R Todd Rokita IN
R Marlin Stutzman IN
D Peter Visclosky IN
R Jackie Walorski IN
R Todd Young IN
R Tim Huelskamp KS
R Lynn Jenkins KS
R Mike Pompeo KS
R Kevin Yoder KS
R Garland Barr KY
R Brett Guthrie KY
R Thomas Massie KY
R Harold Rogers KY
R Ed Whitfield KY
D John Yarmuth KY
R Ralph Abraham LA
R Charles Boustany LA
R John Fleming LA
R Garret Graves LA
D Cedric Richmond LA
R Steve Scalise LA
D Katherine Clark MA
D William Keating MA
D Joseph Kennedy MA
D Stephen Lynch MA
D James McGovern MA
D Seth Moulton MA
D Richard Neal MA
D Niki Tsongas MA
D Elijah Cummings MD
D John Delaney MD
R Andy Harris MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Chellie Pingree ME
R Bruce Poliquin ME
R Justin Amash MI
R Dan Benishek MI
R Mike Bishop MI
D Debbie Dingell MI
R Bill Huizenga MI
D Daniel Kildee MI
D Brenda Lawrence MI
D Sander Levin MI
R Candice Miller MI
R John Moolenaar MI
R Dave Trott MI
R Fred Upton MI
R Tim Walberg MI
D Keith Ellison MN
R Tom Emmer MN
R John Kline MN
D Betty McCollum MN
D Richard Nolan MN
R Erik Paulsen MN
D Collin Peterson MN
D Timothy Walz MN
D Wm. Clay MO
D Emanuel Cleaver MO
R Vicky Hartzler MO
R Billy Long MO
R Blaine Luetkemeyer MO
R Jason Smith MO
R Ann Wagner MO
R Gregg Harper MS
R Steven Palazzo MS
D Bennie Thompson MS
R Ryan Zinke MT
D Alma Adams NC
D George Butterfield NC
R Renee Ellmers NC
R Virginia Foxx NC
R Richard Hudson NC
R Walter Jones NC
R Patrick McHenry NC
R Robert Pittenger NC
D David Price NC
R David Rouzer NC
R Mark Walker NC
R Kevin Cramer ND
D Brad Ashford NE
R Adrian Smith NE
R Frank Guinta NH
D Ann Kuster NH
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
R Leonard Lance NJ
R Frank LoBiondo NJ
R Tom MacArthur NJ
D Donald Norcross NJ
D Frank Pallone NJ
D Albio Sires NJ
D B. Watson Coleman NJ
D Ben Luján NM
D M. Lujan Grisham NM
R Stevan Pearce NM
R Mark Amodei NV
R Cresent Hardy NV
R Joseph Heck NV
D Dina Titus NV
R Chris Collins NY
D Joseph Crowley NY
D Eliot Engel NY
R Christopher Gibson NY
R Richard Hanna NY
D Brian Higgins NY
D Steve Israel NY
R John Katko NY
R Peter King NY
D Nita Lowey NY
D Carolyn Maloney NY
D Sean Maloney NY
D Gregory Meeks NY
D Grace Meng NY
D Jerrold Nadler NY
D Charles Rangel NY
R Tom Reed NY
D Kathleen Rice NY
D José Serrano NY
D Louise Slaughter NY
R Elise Stefanik NY
D Paul Tonko NY
D Nydia Velázquez NY
R Lee Zeldin NY
D Joyce Beatty OH
R Steve Chabot OH
D Marcia Fudge OH
R Bob Gibbs OH
R Bill Johnson OH
R Jim Jordan OH
R David Joyce OH
R Robert Latta OH
R James Renacci OH
R Steve Stivers OH
R Patrick Tiberi OH
R Brad Wenstrup OH
R Jim Bridenstine OK
R Tom Cole OK
R Frank Lucas OK
R Markwayne Mullin OK
R Steve Russell OK
D Earl Blumenauer OR
D Suzanne Bonamici OR
D Kurt Schrader OR
R Greg Walden OR
R Lou Barletta PA
D Brendan Boyle PA
D Robert Brady PA
D Matthew Cartwright PA
R Ryan Costello PA
R Charles Dent PA
D Michael Doyle PA
D Chaka Fattah PA
R Michael Fitzpatrick PA
R Mike Kelly PA
R Tom Marino PA
R Patrick Meehan PA
R Tim Murphy PA
R Scott Perry PA
R Joseph Pitts PA
R Keith Rothfus PA
R Bill Shuster PA
R Glenn Thompson PA
D David Cicilline RI
D James Langevin RI
D James Clyburn SC
R Jeff Duncan SC
R Trey Gowdy SC
R Tom Rice SC
R Marshall Sanford SC
R Kristi Noem SD
R Diane Black TN
R Marsha Blackburn TN
D Steve Cohen TN
D Jim Cooper TN
R Scott DesJarlais TN
R John Duncan TN
R Charles Fleischmann TN
R David Roe TN
R Brian Babin TX
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R John Carter TX
D Joaquin Castro TX
R K. Conaway TX
D Henry Cuellar TX
R John Culberson TX
D Lloyd Doggett TX
R Blake Farenthold TX
R Bill Flores TX
R Louie Gohmert TX
D Al Green TX
D Gene Green TX
R Jeb Hensarling TX
R Will Hurd TX
D Sheila Jackson Lee TX
D Eddie Johnson TX
R Sam Johnson TX
R Kenny Marchant TX
R Michael McCaul TX
R Randy Neugebauer TX
D Beto O'Rourke TX
R Pete Olson TX
R Ted Poe TX
R John Ratcliffe TX
R Pete Sessions TX
R Lamar Smith TX
R Mac Thornberry TX
D Marc Veasey TX
D Filemon Vela TX
R Randy Weber TX
R Roger Williams TX
R Rob Bishop UT
R Jason Chaffetz UT
R Mia Love UT
R Chris Stewart UT
D Donald Beyer VA
R David Brat VA
R Barbara Comstock VA
D Gerald Connolly VA
R J. Forbes VA
R Bob Goodlatte VA
R H. Griffith VA
R Robert Hurt VA
R Edward Rigell VA
D Robert Scott VA
R Robert Wittman VA
D Peter Welch VT
D Suzan DelBene WA
D Denny Heck WA
R J. Herrera Beutler WA
D Derek Kilmer WA
D Rick Larsen WA
D Jim McDermott WA
R C. McMorris Rodgers WA
R Dan Newhouse WA
R David Reichert WA
R Sean Duffy WI
R Glenn Grothman WI
D Ron Kind WI
D Gwen Moore WI
D Mark Pocan WI
R Reid Ribble WI
R Paul Ryan WI
R F. Sensenbrenner WI
R Evan Jenkins WV
R David McKinley WV
R Alex Mooney WV
Not Voting (37)
D Raúl Grijalva AZ
D Xavier Becerra CA
R Dana Rohrabacher CA
D Loretta Sanchez CA
D Jackie Speier CA
D Maxine Waters CA
D John Carney DE
R Bill Posey FL
R Austin Scott GA
D David Scott GA
D Luis Gutiérrez IL
D Daniel Lipinski IL
R Peter Roskam IL
D Bobby Rush IL
D Michael Capuano MA
D Donna Edwards MD
D John Conyers MI
R Sam Graves MO
R George Holding NC
R Mark Meadows NC
R Jeff Fortenberry NE
D Bill Pascrell NJ
D Donald Payne NJ
R Christopher Smith NJ
D Yvette Clarke NY
D Hakeem Jeffries NY
D Marcy Kaptur OH
D Tim Ryan OH
R Michael Turner OH
D Peter DeFazio OR
R Mick Mulvaney SC
R Joe Wilson SC
R Stephen Fincher TN
R Kay Granger TX
D Rubén Hinojosa TX
D Adam Smith WA
R Cynthia Lummis WY