H. R. 876 

One Hundred Fourteenth Congress 

of the 

United States of America 

AT THE FIRST SESSION 

Begun and held at the City of Washington on Tuesday, 

the sixth day of January, two thousand and fifteen 

An Act 

To amend title XVIII of the Social Security Act to require hospitals to provide 

certain notifications to individuals classified by such hospitals under observation 

status rather than admitted as inpatients of such hospitals. 

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 ‘‘Notice of Observation Treatment 

and Implication for Care Eligibility Act’’ or the ‘‘NOTICE Act’’. 

SEC. 2. MEDICARE REQUIREMENT FOR HOSPITAL NOTIFICATIONS OF 

OBSERVATION STATUS. 

Section 1866(a)(1) of the Social Security Act (42 U.S.C. 

1395cc(a)(1)) is amended— 

(1) in subparagraph (V), by striking at the end ‘‘and’’; 

(2) in the first subparagraph (W), by striking at the end 

the period and inserting a comma; 

(3) in the second subparagraph (W)— 

(A) by redesignating such subparagraph as subparagraph (X); and 

(B) by striking at the end the period and inserting 

‘‘, and’’; and 

(4) by inserting after such subparagraph (X) the following 

new subparagraph: 

‘‘(Y) beginning 12 months after the date of the enactment 

of this subparagraph, in the case of a hospital or critical access 

hospital, with respect to each individual who receives observation services as an outpatient at such hospital or critical access 

hospital for more than 24 hours, to provide to such individual 

not later than 36 hours after the time such individual begins 

receiving such services (or, if sooner, upon release)— 

‘‘(i) such oral explanation of the written notification 

described in clause (ii), and such documentation of the 

provision of such explanation, as the Secretary determines 

to be appropriate; 

‘‘(ii) a written notification (as specified by the Secretary 

pursuant to rulemaking and containing such language as 

the Secretary prescribes consistent with this paragraph) 

which— 

‘‘(I) explains the status of the individual as an 

outpatient receiving observation services and not as 

an inpatient of the hospital or critical access hospital 

and the reasons for such status of such individual; 
H. R. 876—2 

‘‘(II) explains the implications of such status on 

services furnished by the hospital or critical access 

hospital (including services furnished on an inpatient 

basis), such as implications for cost-sharing requirements under this title and for subsequent eligibility 

for coverage under this title for services furnished by 

a skilled nursing facility; 

‘‘(III) includes such additional information as the 

Secretary determines appropriate; 

‘‘(IV) either— 

‘‘(aa) is signed by such individual or a person 

acting on such individual’s behalf to acknowledge 

receipt of such notification; or 

‘‘(bb) if such individual or person refuses to 

provide the signature described in item (aa), is 

signed by the staff member of the hospital or critical access hospital who presented the written 

notification and includes the name and title of 

such staff member, a certification that the notification was presented, and the date and time the 

notification was presented; and 

‘‘(V) is written and formatted using plain language 

and is made available in appropriate languages as 

determined by the Secretary.’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.