Restoring Medicare’s Promise: Cosponsor the Improving Access to Medicare Coverage Act, H.R. 1421
Sending Office: Honorable Joe Courtney
Sent By:

Request for Cosponsor(s)
Restoring Medicare’s Promise:
Cosponsor the Improving Access to Medicare Coverage Act, H.R. 1421

When Mrs. Scott’s husband, a Medicare beneficiary, lost function of his arms as a result of spinal stenosis, he was rushed to the hospital in Tahlequah, Oklahoma. He spent five days in the hospital under observation before starting his long road to recovery with several weeks at a skilled nursing rehab center. Mrs. Scott was shocked when she received her husband’s medical bill for over $23,000. He was charged for all of his rehab treatment and care at the center because her husband did not have at least three days as an inpatient at the hospital.

Dear Colleague:

There is mounting concern that too many Medicare beneficiaries and their families are being saddled with insurmountable out-of-pocket costs for stays at skilled nursing facilities (SNF) solely because of the technical classification of their hospital stay.

Hospitals are increasingly caring for Medicare beneficiaries under “outpatient observation status” rather than admitting them as inpatients – a billing technicality that has financial ramifications for Medicare patients once they leave the hospital. Although being classified as an observation patient does not affect the level of care a beneficiary receives while in the hospital, it has significant repercussions for Medicare coverage of SNF care.

Under current Medicare statute, patients must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge, in order to have post-hospital care at an SNF covered. Although patients coded as observation may have been hospitalized for that amount of time and have equal medical need for SNF treatment, their post-hospital care is not covered by Medicare. These patients are either forced to return home without the treatment their care team has suggested, or as often happens, are billed astronomical amounts after their stays in an SNF.

Our bipartisan legislation, the Improving Access to Medicare Coverage Act, H.R. 1421 addresses these issues by allowing observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of SNF services.

We ask that you join us to eliminate this unnecessary financial hardship on Medicare beneficiaries and their families. In times of sickness, patients and their families should not have to worry about their hospital billing classification and whether or not Medicare will reimburse their care.

To be an original cosponsor of this legislation, please contact Maria Costigan ( in Rep. Courtney’s office or Katie Brown ( in Rep. Thompson’s office.



Member of Congress Member of Congress

The Improving Access to Medicare Coverage Act is endorsed by:

American Association of Directors of Nursing Services , American Association of Healthcare Administrative Management (AAHAM), American Association of Nurse Assessment Coordination, AARP, American Case Management Association, Aging Life Care Association, American Health Care Association, Association of Jewish Aging Services, Alliance for Retired Americans, American College of Emergency Physicians, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, The Coalition of Geriatric Nursing Organizations, Emergency Nurses Association, The Hartford Institute for Geriatric Nursing, The Jewish Federations of North America, Justice in Aging, Leadership Council of Aging Organizations, LeadingAge, Lutheran Services in America, Medicare Rights Center, n4a – National Association of Area Agencies on Aging, NAELA – National Academy of Elder Law Attorneys, Inc., NAHCA – National Association of Health Care Assistants, NASL – National Association for the Support of Long Term Care, NASOP – National Association for State Long-Term Care Ombudsman Programs, NCHC – National Coalition on Health Care, NCAL – National Center for Assisted Living, National Committee to Preserve Social Security & Medicare, The National Consumer Voice for Quality Long-Term Care, SHM – Society of Hospital Medicine, Special Needs Alliance

Current Cosponsors:

Blumenauer, DeFazio, DeGette, DeLauro, DelBene, Ellison, Grijalva, Heck, Kennedy, Kilmer, Kuster, Langevin, Loebsack, Maloney, McCollum, Peterson, Sensenbrenner, Swalwell, Thompson, Tsongas, Walz, Nolan, Cicilline

Related Legislative Issues

Selected legislative information: Family Issues, HealthCare, Social Security

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