PRINTER'S NO. 1511
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE RESOLUTION
No.
146
Session of
2023
INTRODUCED BY VENKAT, MADDEN, HILL-EVANS, HARKINS, McNEILL,
SAPPEY, PROBST, KHAN, SANCHEZ, SCOTT, STEELE AND D. WILLIAMS,
JUNE 9, 2023
REFERRED TO COMMITTEE ON HEALTH, JUNE 9, 2023
A RESOLUTION
Urging the Congress of the United States and the United States
Department of Health and Human Services to eliminate the
Skilled Nursing Facility Three-Day Rule for Medicare
recipients.
WHEREAS, Medicare is a Federal health insurance program for
individuals 65 years of age or older, individuals younger than
65 years of age who have certain disabilities and individuals of
all ages who have End-Stage Renal Disease; and
WHEREAS, Medicare consists of four parts as follows:
(1) Medicare Part A, which provides hospital insurance.
(2) Medicare Part B, which provides medical insurance.
(3) Medicare Part C, which is known as "Medicare
Advantage," and is a type of Medicare health plan offered by
a private company that includes benefits from Medicare Parts
A and B and usually includes benefits from Medicare Part D.
(4) Medicare Part D, which provides prescription drug
coverage;
and
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WHEREAS, The Medicare program was signed into law on July 30,
1965; and
WHEREAS, In the first six months of the Medicare program, 2.5
million Americans benefited from Medicare-covered hospital care;
and
WHEREAS, As of December 2022, there are more than 2.8 million
Pennsylvanians enrolled in Medicare; and
WHEREAS, An individual who has suffered from a serious
illness, such as a stroke, surgery or extensive treatment for a
heart or respiratory condition, may need skilled nursing care
after the individual has been hospitalized; and
WHEREAS, Moreover, the individual may need close monitoring,
additional care, physical therapy or occupational therapy, which
can be provided in a skilled nursing facility; and
WHEREAS, In order to receive skilled nursing extended care
services coverage, Medicare patients must meet the Skilled
Nursing Three-Day Rule; and
WHEREAS, The Skilled Nursing Facility Three-Day Rule requires
an individual to be admitted as an inpatient for three
consecutive days in order to qualify for admittance to a skilled
nursing facility; and
WHEREAS, A hospital is able to count the admission day for a
patient, but not the discharge day; and
WHEREAS, The day a patient is transferred to the skilled
nursing facility also does not count toward the three-day rule;
and
WHEREAS, Medicare does not allow a health care provider or
hospital to change orders, which means if an individual stays in
the hospital for more than two midnights, those days cannot be
converted to inpatient status after the days have occurred; and
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WHEREAS, If an individual meets the Skilled Nursing Facility
Three-Day Rule, Medicare Part A will cover all costs of the
skilled nursing facility up to a 20-day stay; and
WHEREAS, In order to be eligible, an individual must meet the
following requirements:
(1) The individual must have a benefit period of 60
consecutive days.
(2) The individual must be moved into a skilled nursing
facility that is certified by Medicare.
(3) The individual's doctor must agree that the
individual requires daily skilled care in a facility;
and
WHEREAS, A stay in a skilled nursing facility lasting longer
than 21 to 100 days results in an individual having to pay for
the services; and
WHEREAS, If an individual is not admitted in a hospital as an
inpatient for three consecutive days, skilled nursing facility
costs are not covered and are billed to the individual; and
WHEREAS, Only accountable care organizations under the
Medicare Shared Savings Program have the ability to apply or
participate in a Skilled Nursing Facility Three-Day Rule Waiver;
and
WHEREAS, Accountable care organizations under the Medicare
Shared Savings Program are a group of hospitals, doctors and
other health care providers who work together to give high-
quality care to individuals on Medicare; and
WHEREAS, The Skilled Nursing Facility Three-Day Rule Waiver
sets aside the requirement for the three-day inpatient hospital
stay before a Medicare covered, post-hospital, extended care
service; and
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WHEREAS, The Center for Medicare and Medicaid Innovation
found that accountable care organizations that participated in
the Skilled Nursing Facility Three-Day Rule Waiver did not see
an increase in Medicare costs and beneficiaries under the waiver
had shorter skilled nursing facility length of stays; therefore
be it
RESOLVED, That the House of Representatives of the
Commonwealth of Pennsylvania urge the Congress of the United
States and the United States Department of Health and Human
Services to eliminate the Skilled Nursing Facility Three-Day
Rule for Medicare recipients; and be it further
RESOLVED, That a copy of this resolution be transmitted to
the presiding officers of each house of Congress and each member
of Congress from Pennsylvania.
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