Policy Corner: August 11, 2023
Categories: Policy Corner Archives
Bi-Partisan Lawmakers Introduce Bill to End Surprise Billing for SNF Coverage
On August 4, 2023, Reps. Joe Courtney (D-Conn.), Glenn ‘GT’ Thompson (R-Pa.), Susan DelBene (D-Wash.), and Ron Estes (R-Kans.) re-introduced the bipartisan bill, Improving Access to Medicare Coverage Act of 2023, to ensure that patients qualify for post-hospital Medicare-covered care in a skilled nursing facility (SNF) when they are in a hospital for three or more consecutive days. Under current Medicare law, only time in the hospital that is classified as “inpatient” counts in the calculation of days. Many patients are called “outpatients in observation,” however, even though their “outpatient” care may be indistinguishable from the care provided to “inpatients.” The result of observation status is that patients are forced either to pay for SNF care out-of-pocket or to forego post-hospital care that they need.
During the COVID-19 Public Health Emergency, the three-day requirement was waived, allowing patients to receive SNF care regardless of their hospital status. Now, the policy is being reimposed on beneficiaries, causing confusion, unexpected bills, and delays in care. H.R. 5138 would ensure Medicare covers doctor-recommended, post-acute care by counting the time spent under “observation status” towards the requisite three-day hospital stay for coverage of skilled nursing care.
House Democratic Health Committee Leaders Propose Bill to Lower Prescription Drug Prices
In late July, House Democratic Health Committee leaders announced the introduction of new legislation to further lower prescription drug prices. The bill is being introduced by House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.), Ways and Means Committee Ranking Member Richard E. Neal (D-Mass.), and Education and the Workforce Committee Ranking Member Robert C. “Bobby” Scott (D-Va.). While the Inflation Reduction Act of 2022 allowed Medicare the power to negotiate lower prescription drug prices for seniors, the proposed Lowering Drug Costs for American Families Act will build on this progress by providing those same lower negotiated prices to all Americans who are covered by private health plans. The bill would also ensure that the inflation rebates enacted under the Inflation Reduction Act also apply to individuals covered by private health plans.
CMS Seeks Comments on Accessing Home Health Aide Services
The Centers for Medicare and Medicaid Services (CMS) is seeking public comments to better understand challenges facing Medicare beneficiaries in accessing home health aide services. The request for input is included as part of a proposed rule that sets forth routine updates to Medicare’s home health payment rates for 2024. CMS is seeking feedback to help ensure appropriate access to and provision of home health aide services for all beneficiaries receiving care under the home health benefit. Comments can be submitted online or by mail until 5:00 pm (ET) on August 29, 2023. View the proposed rule here.
CMS Issues Guidance on Hospital Discharges to Post-Acute Care Providers
The Centers for Medicare and Medicaid Services (CMS) has issued a guidance to remind state agencies, accrediting organizations, and hospitals of the requirements for discharges and transfers to post-acute care, including the provision of appropriate patient information to the post-acute provider and caregivers. The guidance identifies areas of concern related to missing or inaccurate patient information, including information related to:
- Medications;
- Durable medical equipment;
- Patients’ underlying diagnoses for patients with serious mental illness (SMI), complex behavioral needs, and/or substance use disorder (SUD) and specific treatments that were implemented to help manage these conditions while in the hospital for another acute condition;
- Patient preferences and goals for care; and
- Communication about a patient’s needs at home, or how their home environment may impact their ability to maintain their health and safety.
- Skin tears, pressure ulcers, bruising, or lacerations, including orders or instructions for cultures, treatments, or dressings;
It also offers recommendations hospitals can use to improve and protect patients’ health and safety during the discharge and transfer process, including information on:
- Using available resources to improve discharge policies and procedures;
- Collaborating with post-acute care (PAC) providers;
- Conducting case reviews of previous discharges to improve the outcomes of future discharges; and
- Enabling access to patient information in electronic health records (EHRs) across hospitals and PAC providers.
Members of Congress Are On Recess
Both the House of Representatives and the Senate are on recess for six weeks. As members are in their home districts, your representative and senators may participate in state and county fairs, parades, and other local community activities. This is always a good time to let them know your concerns regarding brain injury. Feel free to access materials on the BIAA website which may help in advocating for your interests. The Senate is expected to return on Sept. 5, while the House is not expected to return until Sept. 12.