Improving Access to Medicare Coverage Act of 2025
Sponsored By: Representative Courtney
Introduced
Summary
Counting outpatient observation toward the 3-day inpatient stay requirement. The bill would treat time a patient spends in outpatient hospital observation as inpatient days for purposes of qualifying for Medicare coverage of skilled nursing facility services and would deem the end of observation the hospital discharge date unless the patient is admitted.
Show full summary
- Families and Medicare beneficiaries: People who need post-hospital skilled nursing care would more often qualify for Medicare-covered SNF days because observation time would count toward the 3-day requirement.
- Hospitals and clinicians: Hospitals would have a clearer rule on when an observation period becomes the hospital discharge date, which could affect admission decisions and billing practices.
- Administration and past claims: The Secretary of Health and Human Services could implement the change by interim final rule or program instruction. The bill would also let some completed post-hospital care periods be reconsidered if an administrative appeal is filed within 90 days after enactment.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 1 costs, 0 mixed.
Observation time counts for Medicare SNF
If enacted, time you spend in hospital observation would count toward Medicare’s 3-day stay for skilled nursing facility coverage. The day you stop observation would be treated as your hospital discharge date, unless you are admitted as an inpatient then. This would apply to observation services on or after January 1, 2026. The HHS Secretary could implement this through interim final rules or program instructions.
90-day appeal window for past SNF care
If enacted, the new rule would apply to SNF care you finished before the law only if you file an administrative appeal within 90 days after enactment. Appeals already filed would count. If you miss the 90-day deadline, Medicare would not apply the new rule to those past stays, and you could owe large bills.
Sponsors & CoSponsors
Sponsor
Courtney
CT • D
Cosponsors
Thompson (PA)
PA • R
Sponsored 6/12/2025
DelBene
WA • D
Sponsored 6/12/2025
Estes
KS • R
Sponsored 6/12/2025
Golden (ME)
ME • D
Sponsored 7/16/2025
Brownley
CA • D
Sponsored 9/8/2025
Doggett
TX • D
Sponsored 9/15/2025
Davis (NC)
NC • D
Sponsored 9/30/2025
Moore (WI)
WI • D
Sponsored 10/6/2025
Nunn (IA)
IA • R
Sponsored 10/17/2025
Sanchez
CA • D
Sponsored 10/17/2025
Suozzi
NY • D
Sponsored 10/17/2025
Smith (NE)
NE • R
Sponsored 10/21/2025
Ross
NC • D
Sponsored 10/21/2025
Beyer
VA • D
Sponsored 10/31/2025
Pingree
ME • D
Sponsored 11/7/2025
Gottheimer
NJ • D
Sponsored 11/21/2025
Kennedy (NY)
NY • D
Sponsored 11/25/2025
Johnson (TX)
TX • D
Sponsored 11/25/2025
Schneider
IL • D
Sponsored 12/3/2025
Horsford
NV • D
Sponsored 12/3/2025
Rutherford
FL • R
Sponsored 12/3/2025
Mann
KS • R
Sponsored 12/10/2025
Thompson (CA)
CA • D
Sponsored 12/17/2025
Amo
RI • D
Sponsored 1/7/2026
Tlaib
MI • D
Sponsored 2/3/2026
Scanlon
PA • D
Sponsored 2/3/2026
Lynch
MA • D
Sponsored 2/10/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 2/17/2026
Meuser
PA • R
Sponsored 3/4/2026
Raskin
MD • D
Sponsored 3/4/2026
Roll Call Votes
No roll call votes available for this bill.
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