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05/21/2024 01:23 PM
Pennsylvania House of Representatives
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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: May 31, 2023 07:32 PM
From: Representative Arvind Venkat
To: All House members
Subject: Eliminating the Medicare Skilled Nursing Facility Three-Day Rule
As of December 2022, there are more than 2.8 million Pennsylvanians enrolled in Medicare. Medicare beneficiaries who have suffered from a serious illness, such as a stroke, surgery, or other significant condition, may need skilled nursing care after they have been hospitalized. A skilled nursing facility can provide an individual with close monitoring, additional care, physical therapy, or occupational therapy.
However, Medicare’s 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. Hospitals are allowed to count a patient’s admission day but not their discharge day or their transfer day to a skilled nursing facility toward their three consecutive days.  If an individual is not admitted as an inpatient for three consecutive days, the individual is required to cover all skilled nursing facility costs, with the average cost being around $11,000 a month.
During the height of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) waived the three-day rule. It is abundantly clear from that experience that this rule serves little clinical purpose, impedes the progress of patient care, and does not save money. Unfortunately, with the end of the public health emergency, the CMS waiver is no longer in place. I believe it is important to increase the accessibility of high quality, patient-centered care for all Pennsylvanians. For these reasons, I will be introducing a resolution that would urge the United States Congress and the United States Department of Health and Human Services to eliminate the Skilled Nursing Facility Three-Day Rule for Medicare recipients.
Please join me in this effort to improve the health and wellness of Pennsylvanians who are in need of skilled nursing facility care without the extra worry of exorbitant costs if they do not meet antiquated Medicare requirements.

Introduced as HR146