News Feature | April 15, 2014

Observation Status Bill Gains Support

Christine Kern

By Christine Kern, contributing writer

Observation Status Bill

Courtney’s Bill to counter “Two-Midnight Rule” gaining speed, still needs more support

Rep. Joe Courtney (D-CT) has gained significant support for his Observation Status Bill, which would count all days in a hospital – inpatient or observation –toward the necessary three-day stay before Medicare pays for nursing home care, but he acknowledged more support is needed to pass the bill. Although Courtney wanted to attach the legislation to Medicare physician pay legislation, it did not make it into short-term payment patch.

According to Inside Health Policy, Courtney told attendees at the Center for Medicare Advocacy's first "Voices of Medicare" summit in late March that it takes a lot of work to get a bill approved. There's been more pressure in the past year but not enough. Courtney urged industry and beneficiary advocates to "keep pounding away" and pushing for more support from legislators.

The Bill, called the “Improving Access to Medicare Coverage Act of 2013,” proposes “to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.” The bill currently has the support of 140 bipartisan lawmakers, while the past Congress saw only 37 cosponsors.

Courtney said that part of the problem has been getting the Congressional Budget Office and the CMS actuary on the same page with regard to the cost of the bill – and as such the bill doesn't have a price tag. Without knowing costs upfront, many lawmakers are reluctant to sign onto the bill.

The observation status bill did not make it into the latest Sustainable Growth Rate patch, and the lack of a score by CBO might have been why, according to one expert following the issue. Since December, the Center for Medicare Advocacy has been pushing to include the bill in a physician payment reform package, and Courtney has previously said the bill would be a logical attachment.