,,ii  #aadth ,,congress  #ast ,session  
,s4 #acdi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ad1      
#bjae,mr4 ,cardin 7for himself and ,mr4 
,enzi7 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 require hospitals to  
provide certain notifications to        
individuals classified by such hospitals
 under observation status rather than   
admitted as inpatients of such          
hospitals4  #a4 ,short title ,this ,act 
may be cited as the ,notice of          
,observation ,treatment and ,implication
 for ,care ,eligibility ,act or the     
,,notice ,act4  #b4 ,medicare           
requirement for hospital notifications  
of observation status ,section          
#ahff7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is 
amended--  7#a7 in subparagraph 7,v71 by
 striking at the end and2  7#b7 in the  
first subparagraph 7,w71 by striking at 

the end the period and inserting a      
comma2  7#c7 in the second subparagraph 
7,w7-- 7,a7 by redesignating such       
subparagraph as subparagraph 7,x72 and  
7,b7 by striking at the end the period  
and inserting 1 and2 and  7#d7 by       
inserting after such subparagraph 7,x7  
the following new subparagraph3  7,y7   
beginning #ab months after the date of  
the enactment of this subparagraph1 in  
the case of a hospital or critical      
access hospital1 with respect to each   
individual who receives observation     
services as an outpatient at such       
hospital or critical access hospital for
 more than #bd hours1 to provide to such
 individual not later than #cf hours    
after the time such individual begins   
receiving such services 7or1 if sooner1 
upon release7--  7i7 such oral          
explanation of the written notification 
described in clause 7ii71 and such      
documentation of the provision of such  
explanation1 as the ,secretary          
determines to be appropriate2  7ii7 a   

written notification 7as specified by   
the ,secretary pursuant to rulemaking   
and containing such language as the     
,secretary prescribes consistent with   
this paragraph7 which--  7,i7 explains  
the status of the individual as an      
outpatient receiving observation        
services and not as an inpatient of the 
hospital or critical access hospital and
 the reasons for such status of such    
individual2  7,,ii7 explains the        
implications of such status on services 
furnished by the hospital or critical   
access hospital 7including services     
furnished on an inpatient basis71 such  
as implications for cost-sharing        
requirements under this title and for   
subsequent eligibility for coverage     
under this title for services furnished 
by a skilled nursing facility2  7,,iii7 
includes such additional information as 
the ,secretary determines appropriate2  
7,,iv7 either--  7aa7 is signed by such 
individual or a person acting on such   
individual's behalf to acknowledge      

receipt of such notification2 or  7bb7  
if such individual or person refuses to 
provide the signature described in item 
7aa71 is signed by the staff member of  
the hospital or critical access hospital
 who presented the written notification 
and includes the name and title of such 
staff member1 a certification that the  
notification was presented1 and the date
 and time the notification was          
presented2 and  7,v7 is written and     
formatted using plain language and is   
made available in appropriate languages 
as determined by the ,secretary4  4