Here’s an update to a situation that has unfortunately not improved

As posted in previous EHB Insurance Group newsletters, the “observation” vs. “admitted” status of Medicare age people being denied benefits of Medicare Extended Care (skilled care) because their paperwork had not been coded as “admitted” during their hospital stay is still suspended somewhere in time.  This scenario happened to 1.6 million people in 2011, and the problem has grown.  CMS issued its “two midnight rule” this summer, which was supposed to guide hospitals in their interpretation of whether to admit, or code as observation.

So, here’s the update that is a three-fold problem.  First, hospitals are finding the CMS rule confusing, and are unsettled about what CMS actually wants from the hospitals that improves the admitted/observational problem.  Secondly, a lawsuit to remedy the situation (by eliminating the three-day admitted rule) was brought forth by fourteen individuals in Connecticut, a few months ago.  This week, a federal judge dismissed the lawsuit, so even though it would have been beneficial to Medicare enrollees, it can not go forward.  And, third, this week, more than 100 members of the US House called for a six-month delay in implementing the CMS rule described in “First” above, so hospitals are in even greater confusion as to how to interpret the rule, and the problem goes on and on while many people remain in a wait-and-see mode regarding their Extended Care benefits. 

This is troublesome for the patient who has no idea until they are dismissed that they may be required to pay thousands of dollars for any stay in the nursing home–regardless of how long it is–and for how much.  This is an excellent reminder to contact EHB Insurance Group about Short-Term Care or Long-Term Care Insurance now, before being caught in a situation. It’s  extremely important!