; rather it simply expands the Secretary’s administrative definition of inpatient for purposes of the 3-day stay requirement to include time spent under observation. As such, it is not a reprise of the Medicare Catastrophic Coverage Act of 1988, which repealed the 3-day requirement. This Act simply restores the original objective of the 3-day rule, which was to ensure Medicare coverage of skilled nursing facility stays following hospital care for patients who stayed in the hospital for 3 days. (9) It is the intent of this Congress, through this Act, to allow access to skilled nursing care for the population of beneficiaries who meet medical necessity requirements for such care, but who do not satisfy the 3-day inpatient stay requirement simply because some or all of their time in the acute care hospital is characterized as outpatient observation status for billing purposes. (10) It is the understanding of Congress that the Secretary of Health and Human Services will monitor patterns of behavior to ensure that providers deliver appropriate and needed levels of care. (11) The Office of the Inspector General of the Department of Health and Human Services is supportive of counting hospital observation days towards the 3-day inpatient stay requirement. In addition, in September 2013, the Congressionally established Commission on Long-Term Care recommended that CMS’ count time spent in observation status toward meeting Medicare’s 3-day stay requirement. In addition, in a December 2016 report, the Office of the Inspector General of the Department of Health and Human Services found that an increased number of Medicare beneficiaries classified as outpatients are paying more for care that is substantively similar, and have limited access to skilled nursing facility care due to their patient status. 3. 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