As noted in previous posts, if a senior visits a hospital emergency room and the staff cannot immediately diagnose the illness, they may place the senior on "Observation Status." That means the senior is still classified as an "outpatient" even though he may spend time in a hospital bed receiving tests and treatments. As a consequence, there is no coverage under Medicare Part A. Coverage may be provided under Medicare Part B, but there may be substantial co-payments, and perhaps no drug coverage.
If the senior is subsequently transferred to a skilled nursing facility (i.e. a nursing home) Medicare Part A coverage will be absent there too, and the senior may have to pay privately for nursing home care at rates approaching $300. per day.
There were some changes in federal Medicare regulations to try to remedy this problem, but they were not very effective.
State legislation cannot provide a total remedy because it is a result of Federal Medicare Regulations rather than state law. But, some proposed Pennsylvania legislation designed to mitigate the problem.
In Pennsylvania House
Bill 1907 (The Hospital Observation Status Consumer Notification Act) has recently
been introduced in the Pennsylvania House by Stan
Saylor (R. York). It would require a hospital to provide notice to a
patient of his or her outpatient status, billing implications and the impact
of the outpatient status on insurance coverage. To understand more about HB
1907 you can read its Co-Sponsorship
Memorandum.
An informational hearing on HB 1907 was held by the Pennsylvania House Aging and Older Adult Services Committee. Testimony in support of
the bill was received from representatives of The Hospital and Healthsystem
Association of Pennsylvania, AARP, and the Pennsylvania Health Care
Association. Also testifying in support was Brad Jacobs, Register of Wills and
Clerk of Orphan's Court in York County, who shared his personal story of the
difficulties encountered due his mother’s observation status hospitalization.
HB 1907 is a step in the right direction, and Representative
Saylor is to be commended for recognizing the problem and trying to address it.
But, a state requirement regarding notification of patients won’t solve the
basic problem. What
is really needed is federal legislation that changes the Medicare rules.
Legislation has been introduced in Congress to address the
observation status problem. Senate bill (S569) and
House bill (HR
1179) would amend the law to provide that time spent under observation in a
hospital counts as inpatient time under Medicare. HR 1179 currently has 135 bipartisan cosponsors in the house. Among Pennsylvania sponsors as of this writing are Rep. Michael G. Fitzpatrick, [R-PA-8], Rep.Allyson Y. Schwartz, [D-PA-13], Rep. Tom Marino,[R-PA-10], Rep.Charles W. Dent,[R-PA-15], Rep. Lou Barletta, [R-PA-11], Rep. Scott Perry, [R-PA-4], Rep. Matt Cartwright,[D-PA-17], Rep.Michael F. Doyle,[D-PA-14], Rep. Robert A. Brady,[D-PA-1].
Robert P. Casey, Jr. is a co-sponsor of the senate bill.
The ball is in the court of
our Congressmen and women. Let’s hope they address the observation status problem soon. If any of our clients have strong feelings about this proposed legislation, we would be happy to write a letter on their behalf and send it to them accompanied by a postage paid envelope addressed to their local representative. For those reading this post who are not clients, we will add your name to a petition with your written permission to do so, via e-mail to: observationpetition@lifespanlegal.com.
