S. 4641

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4641 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4641

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 requirement for coverage of 
skilled nursing facility services under Medicare.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 21, 2026

Ms. Collins (for herself, Mr. Welch, and Mrs. Capito) introduced the 
following bill; which was read twice and referred to the Committee on 
Finance

_______________________________________________________________________

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 requirement for coverage of 
skilled nursing facility services under Medicare.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Improving Access to Medicare 
Coverage Act of 2026''.

SEC. 2. COUNTING A PERIOD OF RECEIPT OF OUTPATIENT OBSERVATION SERVICES 
IN A HOSPITAL TOWARD THE 3-DAY INPATIENT HOSPITAL 
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.
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