,,ii  #aacth ,,congress  #ast ,session  
,s4 #efi  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #ad1 #bjac   
,mr4 ,brown introduced the following    
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,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 #c-;day inpatient hospital         
requirement for coverage of skilled     
nursing facility services under         
,medicare4  #a4 ,short title ,this ,act 
may be cited as the ,improving ,access  
to ,medicare ,coverage ,act of #bjac4   
#b4 ,counting a period of receipt of    
outpatient observation services in a    
hospital toward the #c-;day inpatient   
hospital requirement for coverage of    
skilled nursing facility services under 
,medicare  7a7 ,in general ,section     
#ahfa7;i7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7i77 is amended by 
adding at the end the following3 ,for   

purposes of this subsection1 an         
individual receiving outpatient         
observation services shall be deemed to 
be an inpatient during such period1 and 
the date such individual ceases         
receiving such services shall be deemed 
the hospital discharge date 7unless such
 individual is admitted as a hospital   
inpatient at the end of such period744  
7b7 ,effective date ,the amendment made 
by subsection 7a7 shall apply to receipt
 of outpatient observation services     
beginning on or after ,january #a1      
#bjac1 but applies to a period of       
post-hospital extended care services    
that was completed before the date of   
the enactment of this ,act only if an   
administrative appeal is or has been    
made with respect to such services not  
later than #ij days after the date of   
the enactment of this ,act4             
,notwithstanding any other provision of 
law1 the ,secretary of ,health and      
,human ,services may implement such     
amendment through an interim final      

regulation1 program instruction1 or     
otherwise4