Over 2 million Ohioans are Medicare beneficiaries and rely not just on coverage for their health care services, but also access to the appropriate health care settings.
With nearly 1,000 skilled nursing facilities (SNFs) in our state, such as those operated by Toledo’s own HCR Manor Care, Ohio ranks third in the nation for offering these high-quality health care options to patients in need of post-acute and long-term care settings. Unfortunately, federal law limits Medicare’s coverage of patients’ stays in SNFs, which is why I introduced legislation to enhance access to quality care for Ohio’s seniors.
As a former owner and operator of nursing facilities throughout Northeast Ohio, I understand the challenges families face when deciding upon the appropriate healthcare setting for their loved ones. From my experience, I also understand that too often, our nation’s seniors are being subjected to the wrong healthcare setting and are being denied the reimbursement they need.
Medicare covers up to 100 days of care in SNFs for each healthcare episode a patient experiences. However, current law also requires patients to first have an inpatient hospital stay of three or more consecutive days in order to meet Medicare criteria for reimbursement. Under this policy, even if physicians know that the proper care setting for a beneficiary is an SNF, the beneficiary must first have an inpatient hospital stay in order to qualify for Medicare coverage.
Regrettably, many seniors are often unaware of their patient status because they receive the same care whether they are admitted as inpatient or outpatient. When they seek to transition to care to a SNF, they are surprised to find they are not eligible for Medicare coverage.
The Office of the Inspector General reported that while over 617,000 beneficiaries had hospital stays lasting three or more nights, they did not qualify for SNF coverage under Medicare because their stays did not include three inpatient nights. Instead, they were left on the hook for their nursing care and other post-acute care services.
I find this policy unacceptable. Beneficiaries in need of skilled nursing care are among the frailest and oldest of the Medicare population, and they should not be shut out of these critical services because of nonsensical government policy. In fact, most Medicare Advantage plans have already eliminated the requirement.
I am not alone in my opposition to this requirement. Many medical professionals throughout the country support eliminating the three-day requirement and the Commission on Long-Term Care has called on Congress to remove it as well. Companies such as HCR ManorCare, which tend to the patients most affected by this rule, understand that eliminating it would provide our patients with more accurately designated care.
Furthermore, Medicare’s three-day requirement is arbitrary and holds no clinical basis, forcing patients most in need of SNFs to first have unnecessary hospital stays. A study by Brown University found no evidence that eliminating the requirement would affect the number of admissions or length of patients’ stays in SNFs.
To that end, I am introducing the Creating Access to Rehabilitation for Every Senior (CARES) Act. This commonsense legislation eliminates this three-day requirement to protect Medicare beneficiaries’ access to skilled nursing care and to reduce barriers to healthcare services for Ohio’s seniors. The CARES Act would allow SNFs that meet stringent criteria used by the Centers for Medicare and Medicaid Services to automatically waive the prior hospitalization requirement.
The CARES Act better serves patients by providing access to quality care that is the right care at the right time in the right setting. Additionally, it would reduce costs in our already-strained healthcare system by waiving the need for a three-day stay in an expensive, inpatient hospital setting and shifting funds toward patient-centered care settings such as an SNF.
This legislation is practical, and the reforms it offers are widely-supported within the industry and are long overdue. It’s time we step up and make sure Ohio’s seniors receive the treatment they need when they need it.