114TH CONGRESS 
1ST SESSION 
H. R. 876 
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 Representa-
tives 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 NOTIFI-
CATIONS 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 hos-
pital for more than 24 hours, to provide to such in-
dividual not later than 36 hours after the time such
individual begins receiving such services (or, if soon-
er, upon release)— 
‘‘(i) such oral explanation of the written 
notification described in clause (ii), and such 
documentation of the provision of such expla-
nation, as the Secretary determines to be ap-
propriate; 
‘‘(ii) a written notification (as specified by 
the Secretary pursuant to rulemaking and con-
taining such language as the Secretary pre-
scribes consistent with this paragraph) which— 
‘‘(I) explains the status of the indi-
vidual as an outpatient receiving observa-
tion services and not as an inpatient of the 
hospital or critical access hospital and the 
reasons for such status of such individual; 
‘‘(II) explains the implications of such 
status on services furnished by the hospital 
or critical access hospital (including serv-
ices furnished on an inpatient basis), such 
as implications for cost-sharing require-
ments under this title and for subsequent 
eligibility for coverage under this title for 
services furnished by a skilled nursing fa-
cility;
‘‘(III) includes such additional infor-
mation as the Secretary determines appro-
priate; 
‘‘(IV) either— 
‘‘(aa) is signed by such individual 
or a person acting on such individ-
ual’s behalf to acknowledge receipt of 
such notification; or 
‘‘(bb) if such individual or person 
refuses to provide the signature de-
scribed in item (aa), is signed by the 
staff member of the hospital or crit-
ical 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 ap-
propriate languages as determined by the 
Secretary.’’. 
Passed the House of Representatives March 16, 
2015. 
Attest: 
Clerk.
114TH CONGRESS 
1ST SESSION 
H. R. 876 
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 inpa-
tients of such hospitals.