If enacted, this bill would significantly impact Medicare beneficiaries who often face barriers to skilled nursing care due to the stringent inpatient requirements. By allowing the time spent in outpatient observation to count towards the 3-day hospital stay, patients would potentially have greater access to skilled nursing services. This policy change could lead to improved health outcomes for patients who require ongoing care after being treated in a hospital setting.
Summary
House Bill 5138, titled the 'Improving Access to Medicare Coverage Act of 2023', aims to amend Title XVIII of the Social Security Act to address the outdated 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare. The bill proposes that periods during which an individual receives outpatient observation services in a hospital be considered as inpatient days for the purposes of this requirement. This change aims to improve access to necessary post-hospital care for patients who have been kept under observation but have not been formally admitted as inpatients.
Contention
Notably, this bill may face contention primarily due to concerns over healthcare policy and Medicare funding. Critics may argue that altering the inpatient requirement could lead to increased costs for the Medicare program, potentially affecting its sustainability. Additionally, there may be discussions around how this change could influence the behavior of hospitals in terms of patient admissions and the delivery of care services, raising questions about the balance between patient care and fiscal responsibility.