NYSUT retirees help change NY hospital policy

When Ike Cassuto, the husband of NYSUT retiree Thalia Cassuto, got a bill for $6,000 for skilled nursing care earlier this year, he wasn’t happy. Now he’s just heard about  another bill — one that will help retirees on Medicare who are in situations like he was in.

Good news was just announced: The governor has signed the Observation Status bill into law, a victory for NYSUT retirees and other union members who helped push the bill.

“Our retiree members should be very proud of their work,” said Kathleen Donahue, NYSUT vice president who oversees health care. “I know we have the federal level to do, but knowing this is law in New York is outstanding!”

Now, New York hospitals are required to provide patients notice within 24 hours whether they are on observation status or inpatient status. In the past, some patients, like Ike, unknowingly were put on observation status while hospitalized instead of being official inpatients. The distinction is important: Observation status means the patient will end up paying more out-of-pocket for their hospital stay.  And those on “observation status” who stayed in the  hospital for the mandatory Medicaid three-day minimum required for followup rehabilitative care at a skilled nursing facility were not covered by their insurance.

Some patients were unable to access this additional care because they could not pay for follow-up skilled nursing care themselves. For others, like Ike, it meant a nasty surprise when he arrived at the nursing facility flat on his back with a broken pelvis. There was no way he could go home. He and his wife, Thalia, a retired New York City teacher and UFT member, have been advocating ever since for a federal law to change the policy. The couple met with U.S. Sen. Charles Schumer, D-NY, at a press conference in Albany in March to promote the change. Schumer is sponsoring a bill in Congress.

“It’s wonderful,” Ike said about the New York law. “I think it’s a beginning and holds out hope for other patients who find themselves in the coils of the observation status system. I’m hoping and waiting for a federal law as well.”

“Every bit of awareness helps. This law raises awareness for the patient and the physicians,” said Thalia Cassuto. But observation status still puts a sometimes staggering financial prospect in front of patients, who are ill and perhaps cannot afford the additional hospital or after-care expenses.  ”There needs to be legislation from Congress saying that any stay in the hospital that lasts three days means that any rehabilitation you require is part of your Medicare coverage.”

Whereas Medicare Part A (hospital insurance) covers all inpatient hospital services through a one-time deductible, Medicare Part B (medical insurance) requires beneficiaries with observation/outpatient status to pay for 20 percent of their hospital/physician services plus the full cost of prescription drugs.

“The distinction between inpatient and outpatient/observation status is a vitally important matter, especially for Medicare beneficiaries as many of them are not informed of their status … and are then hit, blindly, with an exorbitant bill upon discharge,” NYSUT members wrote to New York lawmakers in hundreds of letters and faxes sent from NYSUT’s MAC site (Member Action Center.)

“Much appreciation to all those friends and organizations that pushed this legislation,” said Judy Schultz, a Schenectady Federation of Teachers retiree and activist who  has been working with area labor federations and retiree councils to correct the problem.

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