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SNFs Seek Relief from Three-Day Hospital Stay Requirement

By Christopher Cheney  
   October 09, 2017

Critics call the three-day inpatient stay requirement for patients to qualify for Medicare coverage at a skilled nursing facility archaic, irrelevant, and a threat to patient safety.

Skilled nursing facilities and their partners are pushing hard to reform a half-century-old law that requires a hospital-inpatient stay spanning three midnights to qualify patients for Medicare coverage at nursing homes.

Led by the American Health Care Association, which represents 13,500 long-term and post-acute care facilities, a coalition of nearly three dozen national organizations is seeking to change the law,, contending the three-day stay requirement is outdated and denies Medicare beneficiaries access to medically necessary services.

"On average, hospital stays are much shorter than they were in the 1960s, but the three-day stay requirement still applies to all Medicare patients. … As the hospital stays become shorter, the effect of the three-day rule is to block more and more Medicare beneficiaries from being able to access the skilled nursing facility benefit," says James Michel, senior director of Medicare reimbursement and policy at AHCA.

Under Medicare law, a patient must be categorized as an inpatient at an acute-care hospital for at least a span of three midnights to qualify for Medicare Part A coverage of SNF stays. Patients categorized as under observation at a hospital are considered outpatients under the law, and days under observation do not count toward the three-day stay requirement.

The Improving Access to Medicare Coverage Act of 2017 would allow Medicare beneficiaries to count observation days toward the three-day stay requirement. The 34-member Observation Stays Coalition includes several physician and patient-advocacy organizations, but hospital groups such as the American Hospital Association have not joined the coalition.

The legislation has 21 bipartisan co-sponsors in the Senate and 71 bipartisan cosponsors in the House.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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