U.S. Sen. Charles Schumer on Wednesday called for closing a gap in Medicare coverage that can cost elderly residents more for hospital treatment.
The gap concerns inpatient hospital stays vs. time spent in “observation.” The current rules have Medicare pay for a stay in a skilled nursing home facility if a beneficiary has three consecutive days of hospitalization as an inpatient. If there are fewer than three days, Medicare doesn’t cover post-visit skilled nursing services.
Schumer, D-N.Y., is calling for legislation to change that. The move would make the time spent in observation count toward the three-day stay requirement for Medicare to cover rehab post-hospital visit. The proposal is called the Improving Access to Medicare Coverage Act.
Schumer promoted his proposal with an event Wednesday morning at St. Peter’s Hospital in Albany.
Schumer cited an example of Ike Cassuto, who broke his pelvis and spent four days at St. Peter’s Hospital. Because no operation or procedure was performed, he was listed under “observation status.” That meant that Medicare would not pay for the three weeks in rehab that followed his hospital stay.
Cassuto was left with $6,000 in medical bills, Schumer’s office said.
“In recent years, there’s been a huge uptick in elderly patients under ‘observation status’ at Capital Region hospitals — and it’s leaving seniors high and dry and hospitals no better off,” Schumer said in a statement. “A flawed Medicare law is to blame, and I have a plan to change that, so hundreds of thousands of seniors, like Mr. Cassuto, are not hit with huge rehabilitation bills after a lengthy hospital visit.”
Schumer’s plan would ensure that patients 65 and older are eligible for coverage for their rehabilitation services, as long as they are in the hospital for three days, his office said.