H.R. 3954: Improving Access to Medicare Coverage Act of 2025

This bill, known as the Improving Access to Medicare Coverage Act of 2025, proposes changes to how Medicare counts hospital stays for individuals receiving outpatient observation services. Currently, Medicare requires patients to stay as inpatients for at least three days to qualify for coverage of skilled nursing facility services. The bill aims to address this by allowing time spent in outpatient observation to count toward this three-day requirement.

Key Provisions

• Outpatient Observation Services: The bill recognizes individuals receiving outpatient observation services in a hospital as if they were inpatients during that time. This means that their time under observation would count towards the three-day inpatient stay requirement.
• Effective Date: The changes are set to apply to outpatient observation services starting January 1, 2026. Additionally, it includes a provision for post-hospital care services if an administrative appeal has been made within 90 days of the bill's enactment.
• Implementation: The Secretary of Health and Human Services is authorized to implement these changes through various regulatory means, such as interim final regulations or program instructions.

The intention behind this legislation is to improve access to skilled nursing facilities for patients who have been in hospital observation, thereby potentially allowing for better continuity of care without imposing additional burdens of hospital admissions that may not have been necessary.

Relevant Companies

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