Bill aims to eliminate skilled nursing's 'three-day rule'

Responding to criticism that Medicare is not paying for enough seniors' skilled-nursing care following serious hospitalizations, Rep. Jim McDermott (D-Wash.) has introduced a bill that would eliminate a barrier to rehab care known as the “three-day rule.”

As it stands, the three-day rule says Medicare will not pay for the time that seniors spend in a nursing home recovering from a hospital stay unless they were hospitalized as an inpatient for three days. McDermott's bill, the “Fairness for Beneficiaries Act,” would eliminate the three-day requirement and replace it with a provision that says seniors would need a physician to certify their need for skilled-nursing, regardless of time spent as an inpatient.

Later this month the congressionally created Commission on Long-Term Care will recommend jettisoning the three-day requirement. The commission was created after Congress repealed a provision in the reform law known as the Community Living Assistance and Supports Act, which would have established a voluntary long-term care benefit for seniors funded by payroll taxes.

Repealing the three-day rule would likely increase Medicare costs for skilled-nursing services. But McDermott, a psychiatrist, argued in the Congressional Record on Thursday that the costs for acute-care hospitalizations would decrease at the same time, because patients would no longer be held for three days in a hospital just so they could quality for skilled-nursing coverage.

He also argued that less time inside hospitals would lead to fewer expenses treating Medicare patients who contract infections while receiving care.

Last month, former CMS Administrator Don Berwick told the Boston Globe that he discussed scrapping the rule when he ran Medicare in 2010 and 2011, but critics inside the agency worried patients who didn't truly need skilled nursing would receive it anyway. Berwick said having a doctor verify a patient's condition could help alleviate that concern.

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