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Congress·In Committee

Congress Proposes Bill to Expand Medicare Coverage for Nursing Home Care After Hospital Stays

Improving Access to Medicare Coverage Act of 2025

9 months ago·View on Congress.gov

Legislative Progress

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House
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Key Points

  • Medicare usually only pays for a stay in a skilled nursing facility or rehab center if a patient was first admitted to a hospital as an "inpatient" for at least three days. This bill would change the law so that time spent in "observation status" also counts toward those three days.
  • Many seniors are currently surprised by large bills because hospitals often keep patients for several days under "observation" without officially admitting them. Because observation is considered outpatient care, Medicare currently won't pay for the nursing home care that follows.
  • If passed, this change would take effect on January 1, 2026. It would help ensure that patients receive the Medicare benefits they expect after a long hospital stay, regardless of how the hospital categorized their time there.
  • The bill also includes a way for people who recently finished their care to appeal for coverage. If they were denied coverage in the past because of the 3-day rule, they may be able to get their costs covered if they file an appeal within 90 days of the bill passing.
Healthcare

Impact Analysis

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions
Jun 12, 2025House

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Jun 12, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

2026-01-01

New observation-status counting rule takes effect

If the bill becomes law, time spent under hospital observation status would start counting toward the 3-day stay requirement for Medicare-covered nursing home care. Patients entering observation on or after this date would benefit.

Within 90 days of enactment

90-day appeal window for past denials

People who were previously denied Medicare coverage for nursing facility care because of the observation status loophole would have 90 days after the bill's enactment to file an appeal and potentially get their costs covered retroactively.

Related News

6 articles
LTC News·8 months ago

Lawmakers Push to Let Observation Stays Count for Medicare Nursing Home Coverage

A bipartisan group of House lawmakers has reintroduced the Improving Access to Medicare Coverage Act of 2025. The bill would update Medicare's 60-year-old three-day requirement by counting time spent in the hospital under observation status toward the threshold for nursing home coverage.

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Skilled Nursing News·24 days ago

3-Day Hospital Stay Rule for Nursing Homes Fails to Improve Outcomes, Cut Costs, as Researchers Question 'Rigid' Thresholds

A study in JAMA Internal Medicine found that reinstating the Medicare 3-day rule led to longer hospital stays without reducing nursing home use. Advocates point to the Improving Access to Medicare Coverage Act of 2025 as a solution to count observation days toward this requirement.

C~
CBS News·6 months ago

What is the 3-day rule for Medicare and how does it impact your coverage?

The Medicare 3-day rule requires a three-day inpatient stay for nursing home coverage. The rule is increasingly problematic due to 'observation status,' where hospitals treat patients as outpatients, leaving seniors with massive bills for follow-up care that Medicare refuses to cover.

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Source Information

Document Type

Congressional Bill

Official Title

Improving Access to Medicare Coverage Act of 2025

Bill NumberHR 3954
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(30)
D: 23R: 7

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.