S. 4641: Improving Access to Medicare Coverage Act of 2026

This bill, known as the Improving Access to Medicare Coverage Act of 2026, aims to change how Medicare counts certain hospital stays for patients seeking coverage for skilled nursing care. Here's a breakdown of its key components:

Purpose of the Bill

The main objective is to allow patients who receive outpatient observation services in a hospital to have those days counted as if they were inpatient days. This change is important because Medicare requires a minimum of three inpatient days in a hospital before it will cover skilled nursing facility services. By counting outpatient observation days towards this requirement, more patients may qualify for Medicare coverage for subsequent skilled nursing care.

Details of the Amendment

Specifically, the bill amends Section 1861(i) of the Social Security Act. The amendment states the following:

• If an individual is receiving outpatient observation services, they will be treated as an inpatient for the duration of those services.
• The end of the outpatient observation period will be considered the hospital discharge date unless the patient is admitted as an inpatient afterward.

Effective Date

The changes proposed by this bill would apply to outpatient observation services starting January 1, 2026. For patients who have already completed a period of extended care services before this date, the bill allows for these changes to be considered if an administrative appeal was made regarding their services within 90 days of the bill's enactment.

Implementation

The Secretary of Health and Human Services has the authority to implement these amendments through various means, such as interim final regulations or program instructions. This enables a more immediate application of the changes rather than waiting for the traditional rule-making process.

Summary

In summary, this bill seeks to improve access to skilled nursing facility services for Medicare patients by modifying how certain hospital observation days are counted, potentially allowing more individuals to qualify for necessary care.

Relevant Companies

• HCA Healthcare (HCA) - As a large health system with many hospitals, this company could see increased demand for skilled nursing services due to the expanded Medicare coverage.
• UnitedHealth Group (UNH) - As a major health insurance provider, UnitedHealth may need to adjust its policies and reimbursements in response to the changes in Medicare coverage.