Many SNF administrators are looking forward to the implementation of the NOTICE Act, which requires hospitals to communicate more clearly with Medicare patients about their status as inpatients or outpatients, and the effect of that status on coverage of subsequent SNF care. Research by ABILITY has found that SNF admissions staff frequently experience challenges with eligibility issues at intake, and hopes are high that the new law can help clarify matters for patients and their families.
However, before the law is implemented this August, the American Hospital Association (AHA) is asking CMS to use its rulemaking power to clarify several issues. In public comments released in early January, the association highlighted seven recommendations:
- The AHA is requesting a six-month implementation period after the final rule is issued to allow hospitals time to develop policies and procedures, update IT systems and train staff members.
- The group also requests that CMS better define its enforcement procedures and penalties for noncompliance. “We believe that defaulting to terminating a hospital’s provider agreement in response to a finding of noncompliance with the Act’s provisions would be too egregious a penalty to impose,” the comments state.
- The AHA points out that since hospitals often don’t have access to a patient’s specific coverage information until a claim has been submitted, it would be difficult to communicate specifically with patients about their cost-sharing requirements and eligibility for SNF coverage. The association is therefore asking that CMS allow hospitals to use standard notification language as opposed to “an entirely individualized notification for each beneficiary.”
- The Act states that outpatients must be notified of their status within 36 hours of the observation beginning. But the AHA is asking CMS to clarify what would happen in situations such as when “beneficiaries who have received more than 24 hours of observation care are subsequently admitted to the hospital as inpatients,” and, “a beneficiary is admitted as an inpatient, but is subsequently reverted, via condition code 44, to outpatient status.”
- Regarding the Act’s oral explanation requirement, the AHA asks CMS to allow hospitals to determine who can provide the explanation, rather than CMS setting its own requirements for which staff may provide it.
- The AHA asks CMS to allow hospital staff members to sign the notifications in cases where patients are unable to sign themselves due to medical or mental conditions, and the patients have no other representatives.
- Finally, the association highlights that some states have laws similar to the NOTICE Act, and therefore requests that CMS clarify which requirements have precedence in these states.
While the AHA’s recommendations do draw attention to several matters that need attention before the final rules are issued, the association and many in the provider community have been supportive of the law’s intent.
“When it comes to their care, patients can’t afford not to know if they are ineligible for Medicare’s hospitalization coverage or nursing home benefits,” said a statement by the American Academy of Family Physicians. “This legislation will provide a much needed layer of transparency for many patients who find themselves under medical care within the walls of a hospital, but haven’t officially been admitted.”
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