At what point does Medicare pay for a nursing home stay?
Do you know how many days an individual must be admitted to a hospital before #Medicare will pay for any stay in a #skilledcarefacility or #nursinghome? Simply being kept in the hospital, on "observational status," is insufficient.
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Medicare and observation status by Shelby Hostetter, WFJ Law | Apr 10, 2014
Most people know that Medicare covers a short term stay in a Skilled Care Facility (commonly referred to as a nursing home). While this is true, many people do not know that an individual must be admitted to a hospital for 3 nights before Medicare will pay for any stay in a skilled care facility. See 42 U.S.C. § 1395(x)(i). Simply being kept in the hospital, on "observational status," is insufficient.
Medicare Part A pays for a maximum of 100 days of post-hospital skilled care in a skilled nursing facility but does not pay for long term custodial care. Of that 100 days, the first 20 days are covered in full, while days 21 through 100 although paid for by Medicare, are subject to a daily co-insurance amount owed by the Medicare beneficiary.
More and more clients are discovering that they are being put in the hospital on “observation status” and are not being admitted. The observation status will not trigger any Medicare obligation to pay for a short term stay in a skilled care facility. In addition, there is no obligation for the hospital to tell you whether or not you are on observation status.
Recently, the New York Times ran an article about the roadblocks which the elderly community is facing with respect to observation status. A link to this article can be found below. In New York, hospitals are required to tell you whether or not you are on observation status, but the Times article points out there is no federal law requiring hospitals to inform you of your admission status.
There is currently Pennsylvania Legislation that would require our state to inform patients of their status, similar to New York state law. See PA House Bill 1907. While there are limited methods of recourse for this problem, it is a problem many people face and it is important to be cognizant of it before finding out you must pay out of pocket at the skilled are facility.
Attorney Shelby Hostetter focuses her practice in Estate Administration, Estate Planning, Unemployment Compensation, Workers’ Compensation and Business Law. Attorney Hostetter serves Schuylkill, Berks, Carbon and Dauphin Counties and works out of the Pottsville, Tamaqua, Orwigsburg and Shenandoah office locations.