Medicare and the 3-day rule.
Medicare and the 3-day rule.
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医疗保险和三天规则。
DOI：
10.1111/jgs.12579
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发表时间：
2013
影响因子：
6.3
通讯作者：
Cohen,AndrewB
中科院分区：
文献类型：
--
作者：
Cohen,AndrewB
2001 年 4 月 20 日，当时 101 岁的马里昂·兰德斯因背部、左腿和臀部疼痛前往康涅狄格州的一家医院。在急诊室，她接受了核磁共振检查并接受吗啡治疗。医生决定于 4 月 21 日收治她。4 月 23 日，她被转移到哈特福德艾弗里高地的康复中心。医疗保险后来拒绝承保她的熟练护理住院费用。她收到了一张 11,610 美元的账单。问题在于医疗保险法规中俗称“三天规则”的部分。这是自 1965 年林登·约翰逊 (Lyndon Johnson) 签署法律以来一直存在的要求，即“出院后延伸护理服务”只有“从[个人]住院不少于连续 3 天的医院转院后”才需要支付费用。 1 兰德斯女士在到达急诊室几个小时后才被送入急诊室。如果不计入总时间，则她的逗留时间不够长，没有资格享受 SNF 福利。她与另外两名原告提起集体诉讼。他们认为，住院护理包括入院前急诊室服务，以及为住院观察状态的患者提供的服务。 2006 年，康涅狄格州地方法院不同意，原告于 2008 年向第二巡回法院提起上诉。“无论我们认为这作为政策问题是否合理，”利文斯顿法官写道，“不计算入院前住院时间的决定不存在监管上的不一致。” 2
Marion Landers, then 101 years old, went to a hospital in Connecticut on April 20, 2001 with pain in her back, left leg, and hip. In the emergency room, she underwent an MRI and received morphine. Doctors decided to admit her on April 21. On April 23, she was transferred to the rehabilitation wing at Avery Heights, a facility in Hartford. Medicare later denied coverage for her skilled nursing stay. She received a bill for $11,610.The trouble was the part of the Medicare statute commonly known as “the three-day rule.” This is the requirement, present since Lyndon Johnson signed the law in 1965, that “posthospital extended care services” be paid for only “after transfer from a hospital in which [an individual] was an inpatient for not less than 3 consecutive days.” 1 Ms. Landers had not been admitted until many hours after arriving in the ER. Without that time counted toward the total, her stay had not been long enough to qualify for the SNF benefit. She filed a classaction lawsuit with two other plaintiffs. They argued that inpatient care included preadmission emergency room services, as well as services provided to patients in the hospital under observation status. In 2006, the District Court of Connecticut disagreed, as did the Second Circuit, to whom the plaintiffs appealed in 2008.“Regardless of whether we think it sensible as a policy matter,” wrote Judge Livingston, there is “no regulatory inconsistency in [the] decision not to count pre-admission hospital time.” 2