Capito joins bipartisan effort to protect seniors from high costs of necessary medical care

Bipartisan bill would fix current policy that forces seniors, simply based on their hospital status, to pay for care that Medicare should cover

WASHINGTON, D.C. — U.S. Senator Shelley Moore Capito (R-W.Va.) and a bipartisan group of senators reintroduced their legislation to update a current loophole in Medicare policy that would help protect seniors from high medical costs for the skilled nursing care they require after hospitalization.

The Improving Access to Medicare Coverage Act would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Representative Joe Courtney (D-Conn.) is the lead sponsor of bipartisan companion legislation in the U.S. House of Representatives. 

“West Virginia’s seniors shouldn’t have to pay more for their health care because of a technical loophole in our current Medicare law,” Senator Capito said. “The Improving Access to Medicare Coverage Act is a commonsense bill to right this wrong and protect seniors while they’re recovering in the hospital and at their most vulnerable. This bipartisan effort would take a crucial step forward in improving access to care for our seniors.”

Under the current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care under “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days.

Senator Capito joined U.S. Senators Sherrod Brown (D-Ohio), Susan Collins (R-Maine), and Sheldon Whitehouse (D-R.I.) in reintroducing the legislation.

Specifically, the bill would:

• Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” towards the three-day hospital stay requirement for skilled nursing care.

• Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2021.

The Improving Access to Medicare Coverage Act has been endorsed by more than 30 organizations including, AARP, Alliance for Retired Americans, American Case Management Association, American Health Care Association, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, LeadingAge, National Academy of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security & Medicare, National Consumer Voice for Quality Long-Term Care, and the Society of Hospital Medicine.