114th Congress, Vote 115; House of Representatives #876
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|
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|Not Voting (37)|