In a disappointing ruling, a federal judge in Bridgeport, Conn. deferred to the government's interpretation of the rule that conditions Medicare coverage for SNF care on spending at least three prior calendar days in the hospital.  The statute says that the individual must have been an "inpatient" for those three days, but the government has interpreted that to mean that the three days must have been in formal admission status.  As a consequence, beneficiaries who spend part of the three days in the ER or on outpatient status are not considered to have been inpatient for three days and are not eligible for the follow-up SNF coverage.  Since patients are often formally admitted from the ER or outpatient status in the middle of the night - and could as easily have been admitted prior to midnight if an admitting doctor or hospital bed had been available - the effect of the rule is to deprive people who should have been eligible of their SNF coverage.
 

The Court's lengthy decision (http://www.nysd.uscourts.gov/courtweb/public.htm, go to Landers v. Leavitt; and on Westlaw at 2006 WL 2560297) essentially concludes that the government's interpretation is entitled to sufficient deference that the court should not disturb it.  Since the case had already been certified as a nationwide class, the decision on the merits is applicable throughout the country.  Plaintiffs and their counsel are considering the possibility of an appeal.
 

For information on the case or issue, contact Gill Deford (gdeford@medicareadvocacy.org) or Toby Edelman (tededlman@medicareadvocacy.org) in the Center's Connecticut or Washington offices, respectively.