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    Sunday, May 19, 2024

    Courtney co-sponsoring bill to plug Medicare gap

    New London — Candice Antrop said she didn’t know the ins and outs of Medicare coverage a few years ago when her aunt sustained the first in a series of leg fractures related to osteoporosis.

    But the Quaker Hill resident learned quickly that a major gap in coverage exists for seniors requiring rehabilitation services.

    Because her Aunt Edith, now 98 and living at Beechwood Rehabilitation and Nursing Center on Vauxhall Street, was labeled as having been on “observation status” at the hospital rather than being admitted as an “inpatient,” the family had to drain the life savings of Antrop’s aunt, a former bookkeeper who saved up for years to accumulate a cushion for old age.

    “It’s just very sad and stressful .... when they have to take every dime out of the family’s account,” Antrop said. “ It will continue to happen if something doesn’t change.”

    U.S. Rep. Joe Courtney said Wednesday that he hopes to change the system. Surrounded by a dozen patients at Beechwood, Courtney announced Wednesday that he is co-sponsoring a bill to plug the Medicare gap that can cost families tens of thousands of dollars.

    Courtney, D-2nd District, said the bipartisan Improving Access to Medicare Coverage Act has U.S. Rep. Tom Latham, R-Iowa, as the other lead sponsor. In all, the legislation has attracted 35 co-sponsors and more than 50 endorsements in the U.S. House of Representatives and is expected to be introduced in the Senate by U.S. Sens. John Kerry, D-Mass., and Olympia Snowe, R-Maine.

    The bill attempts to widen Medicare coverage to include people previously denied rehabilitation reimbursements. Under current policy, a person must be labeled as having been “inpatient” for at least three days in a hospital to receive rehabilitation coverage under Medicare, so patients on “observation status” do not qualify for the benefit.

    Courtney said it’s a technicality that wasn’t intended when the Medicare policy was first enacted.

    “We’ve really got to get this measure passed to provide more protection for families,” Courtney said in a brief speech.

    Courtney, who pointed out that he also supported health care reform legislation that successfully closed the so-called “doughnut hole” that led to high prescription costs for some seniors, said the cost nationwide for plugging the coverage gap would be “very small,” though he said numbers are still being worked up.

    The cost to individual families, however, can be significant, since rehab facilities today often charge more than $300 a day. Under Medicare, patients are entitled to as many as 100 days of rehabilitation services if they spend three consecutive days as a fully admitted hospital patient.

    Patients such as Antrop’s aunt who fall prey to the Medicare-coverage gap often watch in horror as their life savings drain away in a matter of months.

    “She worked her whole life ... and saved every dime she possibly could,” Antrop said.

    Courtney said the Medicare coverage issue has been going on for years, but the effect has been growing because hospitals are being more careful than ever to adhere to Medicare rules as federal audits become more aggressive. Hospitals that don’t follow the rules face potentially stiff fines for violating regulations and overcharging the government for medical care.

    Courtney said he tried to get Medicare officials to change their policies but eventually decided an act of Congress was needed to make it clear that anyone receiving three days of hospital care should be covered for rehab services.

    Courtney added that Congress will likely take up the coverage-gap issue in September, when it reconvenes. The fact that Rep. Latham, a golfing buddy of Speaker of the House John Boehner, is behind the bill makes him confident that the measure has some legs.

    “This thing actually has a chance,” he said.

    l.howard@theday.com

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