The president announced on March 13 that the three-day stay requirement will be waived during the COVID-19 pandemic. Further details can be found here.  

Breaking News on Observation Status: A Connecticut District Judge found that certain Medicare beneficiaries who are placed on “observation status” at hospitals, rather than being admitted as inpatients, have the right to appeal to Medicare. The case, Alexander v Azar, is a nationwide class-action suit.

This is important because currently Section 1861(i) of the Act permits Medicare payment for SNF care only when a beneficiary first has an inpatient hospital stay of at least three consecutive days. The recently passed law waives that requirement for beneficiaries who experience dislocations or are affected by the emergency. In addition, CMS is recognizing special circumstances for certain beneficiaries who, prior to the current emergency, had either begun or were ready to begin the process of ending their spell of illness after utilizing all of their available SNF benefit days. Due to the current crisis, CMS also is utilizing the authority under section l8l2(f) providing renewed SNF coverage to beneficiaries without starting a new spell of illness and allowing them to receive up to an additional 100 days of SNF Part A coverage.

As you may recall, Congress and CMS took notice when the Court granted class-action status. This announcement by the District Court moves the suit forward and applies more pressure on Congress and CMS to find a solution. NAHU strongly supports House and Senate bills which would count observation status towards the 3-day hospital stay requirement.

Section 1861(i) of the Act permits Medicare payment for SNF care only when a beneficiary first has an inpatient hospital stay of at least three consecutive days. The recently passed law waives that requirement for beneficiaries who experience dislocations or are affected by the emergency. In addition, CMS is recognizing special circumstances for certain beneficiaries who, prior to the current emergency, had either begun or were ready to begin the process of ending their spell of illness after utilizing all of their available SNF benefit days. Due to the current crisis, CMS also is utilizing the authority under section l8l2(f) providing renewed SNF coverage to beneficiaries without starting a new spell of illness and allowing them to receive up to an additional 100 days of SNF Part A coverage.