By Congressman Jim Renacci (OH-16)
Over 2 million Ohioans are Medicare beneficiaries and rely not just on coverage for their health care services, but also access to the appropriate health care settings.
With nearly 1,000 skilled nursing facilities (SNFs) in our state, Ohio ranks third in the nation for offering these high-quality healthcare options to patients in need of post-acute and long-term care settings. Unfortunately, federal law limits Medicare’s coverage of patients’ stays in SNFs, which is why I introduced legislation to enhance access to quality care for Ohio’s seniors.
As a former owner and operator of nursing facilities throughout Northeast Ohio, I understand the challenges families face when deciding upon the appropriate healthcare setting for their loved ones. From my experience, I also understand that, too often, our nation’s seniors are being subjected to the wrong healthcare setting and are being denied the reimbursement they need.
Current law requires patients to first have an inpatient hospital stay of three or more consecutive days in order to meet Medicare criteria for reimbursement. Under this policy, even if physicians know that the proper care setting for a beneficiary is an SNF, the beneficiary must first have an inpatient hospital stay in order to qualify for Medicare coverage.
Regrettably, many seniors are often unaware of their patient status because they receive the same care whether they are admitted as inpatient or outpatient. When they seek to transition to care to a SNF, they are surprised to find they are not eligible for Medicare coverage.
The Office of the Inspector General reported that while over 617,000 beneficiaries had hospital stays lasting three or more nights, they did not qualify for SNF coverage under Medicare because their stays did not include three inpatient nights. Instead, they were left on the hook for their nursing care and other post-acute care services.
I find this policy unacceptable. Beneficiaries in need of skilled nursing care are among the frailest and oldest of the Medicare population, and they should not be shut out of these critical services because of nonsensical government policy.
To that end, I am introducing the Creating Access to Rehabilitation for Every Senior (CARES) Act. This commonsense legislation eliminates this three-day requirement to protect Medicare beneficiaries’ access to skilled nursing care and to reduce barriers to healthcare services for Ohio’s seniors. The CARES Act would allow SNFs that meet stringent criteria used by the Centers for Medicare and Medicaid Services to automatically waive the prior hospitalization requirement.
The CARES Act will better serve patients by providing access to quality care, at a reduced cost, and will make sure that Ohio’s seniors — and all seniors nation-wide — receive the treatment they need when they need it.
The opinions expressed in “Congressional Corner” reflect the views of the writer and are not necessarily those of TSCL.