New Law Requires Hospitals to Inform Patients of Status

by Elizabeth Q. Boehmcke, Esq.

For many seniors, visits to the hospital become more frequent occurrences than when they were younger. Falls, dizzy spills, and a whole host of other ailments may drive a senior to the emergency room. Unfortunately, if your physician determines for whatever reason that you need more observation or treatment before being sent home, you can spend an extended amount of time in the hospital before being released. Depending on the circumstances of your stay, it may be difficult to determine independently whether you are admitted to the hospital as inpatient or whether you are being held under observation – an outpatient status. Unfortunately, there are significant financial consequences of inpatient versus outpatient status, a fact that many seniors have discovered to their surprise after release from the hospital. A new law in Virginia that became effective July 1, 2015 now seeks to require hospitals to clarify the situation for patients.

Inpatient versus outpatient status makes a crucial difference for Medicare patients. In order to receive payment for skilled nursing care in a rehabilitation or other skilled nursing facility after discharge from the hospital, the patient must have been admitted to the hospital as an inpatient for at least three days (excluding the day of discharge). If the patient meets that test, Medicare will pay the full cost of such skilled care for the first 20 days and there is only a $157.50 per day co-insurance payment for days 21-100. If the patient is not admitted as an inpatient for a sufficient number of days, the patient will likely pay the full cost themselves. This can be extremely frustrating to a patient who was held in the hospital for observation for 24 hours and then admitted for two days as an inpatient. Although the patient may not ever detect the change in status because there is no change in services, Medicare will not cover the skilled nursing.

Also, inpatients at the hospital are subject to Medicare Part A which has a $1,216 deductible. However, thereafter, Medicare pays the entire cost for the first 60 days. Outpatients are subject to Medicare Part B which has a $147 deductible, but also must pay a co-payment for diagnostic non-laboratory tests and x-rays. Co-pays for significant amounts of services, tests, and time in the hospital can easily add up to more than the Medicare Part A deductible. Thus, it is critically important to the patient to know his or her status an inpatient or outpatient and whether and when that may change over the course of a hospital stay.

As a result of the fact that it can be difficult to differentiate observational status from inpatient status in many cases, Virginia became the fifth state in the nation to enact legislation designed to notify patients of their status. Under the new law, if a patient receives meals and a hospital bed in an area outside of the emergency department, the hospital must provide written and oral notification within 24 hours of the patient’s outpatient or observational status. The notice itself must also include a notice that observation status can affect the patient’s Medicare or other insurance coverage of the current hospital stay and coverage for skilled nursing care at a rehabilitation or nursing facility after discharge from the hospital. Finally, the notice must provide the patient with information about whom to contact for more information and to determine if there is any available recourse. Although there may be no way to change a patient’s status from observational to inpatient, the knowledge of his or her status can help a family make realistic discharge plans. If the patient does not have the financial resources to pay for skilled nursing out-of-pocket and his or her observational status is known, the family can at least work with the hospital’s discharge planners to create a safe discharge plan that may involve some at-home skilled care that may be more affordable for the patient short-term.

The attorneys at the Hook Law Center work zealously to keep up with the most recent developments in the law that affect our clients. Please join Andy Hook and me for a seminar entitled “What You Don’t Know Can Hurt You: Recent Developments in Estate, Long-Term Care & Special Needs Planning” to be held on July 30, 2015 at the Hilton Garden Inn (Suffolk) at 10 AM and July 31, 2015 at the Crowne Plaza (Virginia Beach) at 10 AM . We will discuss this new law and others that affect seniors in Virginia.  To register, call 757-399-7506 today.

Kit Kat

Ask Kit Kat: Paw Tracks

Hook Law Center: Kit Kat, what can you tell us about the new book called Paw Tracks Here and Abroad: A Dog’s Tale?

Kit Kat: Well, this is a new book by Jim Wilson, owner of the beloved Snickers, a terrier mix. Snickers lived to be almost 22 years old—quite a feat for any pet! Snickers became part of the Wilson family in the early 1980s after being noticed by a neighbor. It was quickly determined that she was a stray, and the Wilsons took her in. The vet who examined her initially felt she had been abused, but that didn’t discourage the Wilsons of Peoria, Illinois. Despite her history, she lived to a ripe, old age.

The Wilsons were so fond of Snickers that Jim started keeping a diary of her adventures. These tales included her travels with Jim and his family, whose career necessitated living all over the world. One could say that little Snickers became an ambassador of good will for the United States abroad. However, it was urging from his family and grandchildren that caused him to write the book. After visiting an ASPCA shelter in New York City with his grandchildren, he finally decided to put his thoughts in writing. Jim says, ‘ We have always been aware of the outstanding work the ASPCA has done for so long. I wrote my book to facilitate discussions about the joys of adopting a pet, the responsibilities of caring for a pet, and the many ways in which we learn from animals.’

Couldn’t have said it better myself! So if you want a good book to ready to your children or any young people for that matter, this is a great choice! (Supporter Profile: Jim Wilson, ASPCA Action, Spring/Summer 2015, p. 17)

Upcoming Seminars and Events

  • July 29, 2015 – Andrew H. Hook will be a guest expert on WNIS’ “Ask the Expert” show.  The broadcast will begin at 6 p.m. on AM790.
  • July 30 & 31, 2015 – The Hook Law Center Seminar for July, What You Don’t Know Can Hurt You – Recent Developments in Estate, Long Term Care and Special Needs Planning, will be held at 10am on Thursday, July 30, 2015 at the Hilton Garden Inn – Harbour View and at 10am on Friday, July 31, 2015 at the Crowne Plaza Hotel – Towne Center.  To register, please call 757-399-7506 and ask for Debbie or register online at hooklawcenter.com/seminars.
  • August 5, 2015 – Andrew H. Hook will present to the staff of Personal Touch Home Health Services in Newport News, VA.
  • August 5 – 7, 2015 – Andrew H. Hook will attend a 3-day financial planning conference in Tyson’s Corner, VA.
  • August 12, 2015 – Andrew Hook will be speaking to a group at Maryview Hospital in Portsmouth, Virginia.
  • August 20, 2015 – Andrew Hook will be speaking on Veterans Benefits at The Chesapeake.
  • August 21, 2015 – Andrew Hook will be speaking to a group at DePaul Hospital in Norfolk, Virginia.
  • August 22, 2015 – Hook Law Center is sponsoring “Shred with a Purpose” to be held at our Virginia Beach office, 295 Bendix Road, from 9am until 12Noon.  Donations to the Alzheimer’s Association for the “Walk to End Alzheimer’s” will also be accepted.  For more information, please call 757-399-7506 or click the following link to view the event flyer: Shred With A Purpose Flyer.
  • August 27, 2015 – Andrew Hook will be speaking to a group at Mary Immaculate Hospital in Newport News, Virginia.
  • September 9, 2015 – Andrew Hook will be speaking at a Virginia Continuing Legal Education seminar.
  • October 9, 2015 – Andrew H. Hook will be part of a panel discussion at the 2015 Art of Healthy Aging Forum & Expo on Friday, October 9, 2015, at the  Virginia Beach Convention Center, 100 19th Street, Virginia Beach, VA 23451.  The forum & expo runs from 9 a.m. – 2 p.m.  Tickets are $15 until September 30th (limited seating). $25 at the doorTo register for this event, please click registration.
  • October 26, 2015Shannon Laymon-Pecoraro will be speaking at the National Business Institute’s seminar on The Probate Process from Start to Finish in Virginia Beach, Virginia.

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