H.R. 3954House119th Congress (2025-2027)In Committee

Improving Access to Medicare Coverage Act of 2025

Introduced June 12, 2025

AI-Generated Summary

Updated November 24, 2025 at 12:01 AM UTC

The Improving Access to Medicare Coverage Act of 2025 updates Medicare’s rules so that outpatient observation time in a hospital counts toward the three‑day inpatient stay required for skilled‑nursing‑facility coverage. This change helps patients who are placed under observation rather than admitted as inpatients to qualify for SNF benefits. The amendment applies to observation stays starting January 1, 2026, and offers a limited retroactive option for appeals filed within 90 days of enactment.

Key Provisions

  • Changes the Medicare rule so that time a patient spends in outpatient observation at a hospital counts as if they were an inpatient for the purpose of meeting the three‑day stay needed to qualify for skilled‑nursing‑facility (SNF) coverage.
  • Treats the day a patient stops observation as the hospital discharge date, unless the patient is formally admitted as an inpatient at that point.
  • The new counting rule takes effect for observation stays that begin on or after January 1, 2026.
  • If a patient’s post‑hospital extended‑care (e.g., SNF) claim was denied before the law’s enactment, they can still use the new rule if they file an administrative appeal within 90 days of the law’s passage.

Legislative Activity

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HouseIntro Referral Latest Action

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

June 12, 2025

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HouseIntro Referral

Introduced in House

June 12, 2025

HouseIntro Referral

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

June 12, 2025

Bill Text

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Introduced in HouseIssued June 12, 2025

I

119th CONGRESS

1st Session

H. R. 3954

IN THE HOUSE OF REPRESENTATIVES

June 12, 2025

Mr. Courtney (for himself, Mr. Thompson of Pennsylvania, Ms. DelBene, and Mr. Estes) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.

1.

Short title

This Act may be cited as the Improving Access to Medicare Coverage Act of 2025.

2.

Counting a period of receipt of outpatient observation services in a hospital toward the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under medicare

(a)

In general

Section 1861(i) of the Social Security Act (42 U.S.C. 1395x(i)) is amended by adding at the end the following: For purposes of this subsection, an individual receiving outpatient observation services shall be deemed to be an inpatient during such period, and the date such individual ceases receiving such services shall be deemed the hospital discharge date (unless such individual is admitted as a hospital inpatient at the end of such period)..

(b)

Effective date

The amendment made by subsection (a) shall apply to receipt of outpatient observation services beginning on or after January 1, 2026, but applies to a period of post-hospital extended care services that was completed before the date of the enactment of this Act only if an administrative appeal is or has been made with respect to such services not later than 90 days after the date of the enactment of this Act. Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement such amendment through an interim final regulation, program instruction, or otherwise.