Perry
Perry

The view of a controversial Medicare rule that's surprising seniors with big bills must be the same from both sides of the aisle.

Two of York County's federal lawmakers, a Republican and a Democrat in different chambers of Congress, support the same legislation to change the rule and potentially save seniors from thousands of dollars in unexpected medical costs.

Rep. Scott Perry, R-York County, and Sen. Bob Casey, D-Pa., are both co-sponsors of identical House and Senate bills to clear up a costly technicality.

Under the current, hotly opposed rule, Medicare patients who go to a hospital must be "admitted" for three days before Medicare will kick in its fullest contribution for the following stay in a rehab or in a skilled nursing facility.

Casey
Casey

But some hospitals have been classifying patients in an "observation" status for days to avoid "admitting" them, so the hospital can steer clear of possible reimbursement issues for having a high rate of "re-admission" under other Medicare rules.

As a result of being stuck in "observation status" for a couple of days, patients foot a bigger portion of the bills for stays in facilities that can cost tens of thousands of dollars per month.

Seniors have been calling the offices of state and federal legislators to complain.

And while state legislators recently passed a "Band-Aid" bill that requires hospitals to at least tell patients what their admission status is, the York County author of the bill warned the federal government needs to change the Medicare rule that's causing all the fuss. Perry and Casey agree.

The changes: Casey is one of 25 senators to co-sponsor Senate Bill 569, while Perry is one of 144 co-sponsors of an identical bill called HR 1179 in the House.

The legislation, called the "Improving Access to Medicare Coverage Act," would change the admission standard to count outpatient "observation" time spent in a hospital toward the three-day inpatient hospital stay required before Medicare pays for subsequent nursing or rehab services.

Perry said the problem arose after the passage of the Affordable Care Act, when the "bureaucrats" started writing policy to correspond with the law.

Hospitals can risk Medicare reimbursement if their re-admission rates are too high, so they started using "observation'' status instead of "admission'' status for some patients, Perry said.

The hospitals aren't the villains; they were "acting within the guidelines that were set up," causing unintended consequences under the health care law, he said.

"(Hospitals) are following the rule and staying out of re-admission, and seniors who are sick and on Medicare are footing the bill for that," he said. "(Seniors) had no clue. They were sick and ... made the presumption their policy will be charged accordingly. It's a loophole that nobody thinks of when they're sick."

Getting it passed: Perry said the state-level legislation, introduced by House Majority Whip Stan Saylor, R-Windsor Township, could at least let seniors know they're in for a big bill. But the federal action is necessary to fully correct the problem, he said.

"If I went to the hospital for something, a thump to my head, and I'm laying there on the gurney and the practitioner says, 'I just want to let you know, Mr. Perry, you're in observation status.' I'd say, 'Great, do what you have to do.'"

But he would still have to face the cost, he said.

Perry said he has been urging leadership to vote on the measure, and he's confident the House will pass it. But there's no vote scheduled, and he's unsure if the bill will pass the Senate because "it could be seen as an attack" on the Affordable Care Act.

But Casey's on board, as is 25 percent of the Senate.

"When someone enters a nursing home because of disability or illness, the focus should be on getting well, not getting bills generated because of classification into which they're thrust," Casey said. "The bill now has 25 co-sponsors and that's an indication it's a problem that prevails across a number of states. ... We just have to find the right time and the right vehicle within which to get it passed."

Sen. Pat Toomey, R-Pa., who's not listed as a co-sponsor on the Senate bill, could not be reached for comment. He sent this statement:

"Medicare is a valuable program that provides health care coverage to millions of Americans. Unfortunately, the program is also riddled with arcane reimbursement structures that too often leave beneficiaries without a clear understanding of their benefits. I favor making Medicare more transparent for beneficiaries, and will continue to look for ways to modernize the program to deliver better outcomes more efficiently."