,,ii #aad? ,,congress #a/ ,session ,s4 #hdc ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #bd1 #bjae,mr4 ,br[n 7= himself1 ,ms4 ,coll9s1 ,mr4 ,nelson1 & ,mrs4 ,capito7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to c\nt a p]iod ( receipt ( outpati5t obs]vation s]vices 9 a hospital t[>d satisfy+ ! #c-;day inpati5t hospital requirem5t = cov]age ( skill$ nurs+ facility s]vices "u ,m$ic>e4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,improv+ ,access to ,m$ic>e ,cov]age ,act ( #bjae4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,m$ic>e requires b5efici>ies to be hospitaliz$ = m$ically necess>y inpati5t hospital c>e = at lea/ ?ree consecutive days be=e cov]+ po/-hospital c>e 9 a skill$ nurs+ facility4 7#b7 ,(t5 pati5ts rema9 "u obs]vation /atus 9 ! hospital = sev]al days4 ,^! days are n c\nt$ t[>d ! #c-;day inpati5t /ay requirem5t because !y are consid]$ outpati5t days4 7#c7 ,hospitals' use ( obs]vation /ays has increas$ %>ply s9ce #bjjf4 ,accord+ to ! ,m$ic>e ,paym5t ,advisory ,commission's ,m>* #bjad report1 outpati5t visits1 _m ( :i* are obs]vation /ays1 increas$ #bh4e p]c5t betwe5 #bjjf & #bjab1 ) a simultane\s #ab4f-p]c5t decrease 9 inpati5t /ays ov] ?is same #f-ye> "t p]iod4 ,a /udy publi%$ 9 ,heal? ,affairs f\nd a #cd-p]c5t increase 9 ! ratio ( obs]vation /ays to inpati5t admissions betwe5 #bjjg & #bjji1 lead+ ! rese>*]s to conclude t outpati5t obs]vation /atus 0 becom+ a sub/itute = inpati5t admission4 ,! same /udy also docum5t$ increases 9 long-/ay outpati5t /atus1 includ+ an #hh-p]c5t increase 9 obs]vation /ays exce$+ #gb h\rs4 7#d7 ,to heal? c>e provid]s1 c>e provid$ dur+ obs]vation is indi/+ui%able f ! c>e provid$ to inpati5ts1 ) all m$ically necess>y c>e be+ provid$1 reg>dless ( pati5t /atus4 ,b5efici>ies are g5]ally n in=m$ ( _! inpati5t or outpati5t /atus & assume t !y are inpati5ts :5 !y are plac$ 9 a hospital b$1 only to f9d out t su* c>e 0 n c\nt$ = purposes ( satisfy+ eligibility requirem5ts = m$ically prescrib$ ,m$ic>e cov]age ( po/-hospital c>e 9 a skill$ nurs+ facility4 7#e7 ,old] ,am]icans & p ) disabilities :o are hospitaliz$ b d n meet ! #c-;day inpati5t hospital ?re%old simply because !y 7 plac$ 9 outpati5t obs]vation /atus = "s or all ( _! hospital /ay 7ev5 :5 _! total actual /ay exce$s #c days 9 ! hospital71 c face a significant & unexpect$ f9ancial burd51 :i* c am\nt to ?\s&s ( doll>s1 = skill$ nurs+ facility c>e4 ,among b5efici>ies :o receiv$ c>e 9 a skill$ nurs+ facility t ,m$ic>e did n cov]1 av]age out-(-pocket *>ges 7 m ?an #aj1jjj accord+ to ! ,(fice ( ,inspector ,g5]al4 7#f7 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7,,cms7 attempt$ to provide hospitals ) cl>ity on :i* pati5ts %\ld be categoriz$ z inpati5ts 9 its ,fiscal ,ye> #bjad inpati5t paym5t rule4 ,h[ev]1 ?is rule fails ,m$ic>e b5efici>ies because x does n address ! problem & explicitly /ates t days sp5t 9 obs]vation d n c\nt = purposes ( satisfy+ ! #c-;day inpati5t /ay requirem5t4 7#g7 ,because ( ,,cms' policy1 :i* indicates days "u obs]vation d n c\nt t[>ds ! #c-;day inpati5t /ay requirem5t1 "s pati5ts "u obs]vation & _! families w cont9ue to face a significant1 (t5 insurm\ntable f9ancial burd5 if !y ne$ skill$ nurs+ c>e aft] _! hospital /ay4 7#h7 ,! am5dm5t made by ?is ,act w\ld update ,m$ic>e policy by deem+ pati5ts "u obs]vation z inpati5ts = ! purposes ( satisfy+ ! #c-;day inpati5t /ay requirem5t4 ,su* am5dm5t does n repeal ! #c-;day inpati5t /ay requirem5t1 r x simply exp&s ! ,secret>y ( ,heal? & ,human ,s]vice's adm9i/rative def9ition ( inpati5t = purposes ( ! #c-;day inpati5t /ay requirem5t to include "t sp5t "u obs]vation4 ,z su*1 x is n a reprise ( ! ,m$ic>e ,cata/rophic ,cov]age ,act ( #aihh1 :i* repeal$ ! #c-;day requirem5t & result$ 9 *urn+ ( pati5ts back & =? f non-,m$ic>e paym5t s\rces to ,m$ic>e ,su* am5dm5t simply re/ores ! orig9al objective ( ! #c-;day rule1 :i* 0 to ensure t ,m$ic>e cov]$ skill$ nurs+ facility /ays t foll[$ hospital c>e = pati5ts :o /ay$ 9 ! hospital = #c days4 7#i7 ,x is ! int5t ( ?is ,congress1 ?r\gh su* am5dm5t1 to all[ access to skill$ nurs+ c>e = ! population ( b5efici>ies :o meet m$ical necessity requirem5ts = su* c>e1 b :o d n satisfy ! #c-;day inpati5t /ay requirem5t simply because "s or all ( _! "t 9 ! acute c>e hospital is *>act]iz$ z outpati5t obs]vation /atus = bill+ purposes4 7#aj7 ,x is ! und]/&+ ( ?is ,congress t ! ,secret>y ( ,heal? & ,human ,s]vices w monitor patt]ns ( behavior to ensure t provid]s deliv] appropriate & ne$$ levels ( c>e4 7#aa7 ,! ,(fice ( ! ,inspector ,g5]al ( ! dep>tm5t ( ,heal? & ,human ,s]vices is supportive ( c\nt+ hospital obs]vation days t[>ds ! #c-;day inpati5t /ay requirem5t4 ,9 addition1 9 ,septemb] #bjac1 ! congressionally e/abli%$ ,commission on ,long-,t]m ,c>e recomm5d$ t ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices c\nt "t sp5t 9 obs]vation /atus t[>d meet+ ,m$ic>e's #c-;day inpati5t /ay requirem5t4 #c4 ,c\nt+ a p]iod ( receipt ( outpati5t obs]vation s]vices 9 a hospital t[>d ! #c-;day inpati5t hospital requirem5t = cov]age ( skill$ nurs+ facility s]vices "u ,m$ic>e 7a7 ,9 g5]al ,section #ahfa7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7i77 is am5d$ by add+ at ! end ! foll[+3 ,= purposes ( ?is subsection1 an individual receiv+ outpati5t obs]vation s]vices %all be deem$ to be an inpati5t dur+ su* p]iod1 & ! date su* individual ceases receiv+ su* s]vices %all be deem$ ! hospital dis*>ge date 7unless su* individual is admitt$ z a hospital inpati5t at ! end ( su* p]iod744 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to receipt ( outpati5t obs]vation s]vices beg9n+ on or aft] ,janu>y #a1 #bjae1 b applies to a p]iod ( po/-hospital ext5d$ c>e s]vices t 0 complet$ be=e ! date ( ! enactm5t ( ?is ,act only if an adm9i/rative appeal is or has be5 made ) respect to su* s]vices n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act4 ,not)/&+ any o!r provision ( law1 ! ,secret>y ( ,heal? & ,human ,s]vices may implem5t su* am5dm5t ?r\gh an int]im f9al regulation1 program in/ruction1 or o!rwise4