I 
113TH CONGRESS 
2D SESSION 
H. R. 5232 
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. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 29, 2014 
Mr. DOGGETT (for himself and Mr. YOUNG of Indiana) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
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’’. 
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SEC. 2. MEDICARE REQUIREMENT FOR HOSPITAL NOTIFI-
CATIONS OF OBSERVATION STATUS. 
(a) IN GENERAL.—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) in the case of a hospital, to provide to 
each individual who is entitled to benefits under part 
A and who the hospital classifies for more than 24 
hours as an outpatient under observation status or 
any other similar status, as the Secretary determines 
appropriate (or to a person acting on the individual’s 
behalf), not later than 36 hours after the time of 
such classification of such individual under such sta-
tus (or, if sooner, upon discharge), an adequate oral 
and written notification (as defined by the Secretary 
pursuant to rulemaking and containing such lan-
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guage as the Secretary prescribes consistent with 
this paragraph) which— 
‘‘(i) explains the status of the individual as 
an outpatient under such observation status or 
any other such similar status and not as an in-
patient of the hospital; 
‘‘(ii) explains the reason for the classifica-
tion of such individual under such status; 
‘‘(iii) explains the implications of such sta-
tus as an outpatient on— 
‘‘(I) eligibility for coverage of items 
and services under this title, including such 
items and services furnished by the hos-
pital with respect to such individual while 
under such status and for items and serv-
ices under this title for a subsequent dis-
charge to a skilled nursing facility or other 
facility; and 
‘‘(II) cost-sharing requirements under 
this title, including with respect to items 
and services furnished by the hospital to 
such individual while under such status 
and with respect to items and services 
under this title for a subsequent discharge 
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to a skilled nursing facility or other facil-
ity; 
‘‘(iv) includes the name and title of the 
staff of the hospital who provided the oral noti-
fication and the date and time of such oral noti-
fication; 
‘‘(v) includes such additional information 
as the Secretary deems appropriate; and 
‘‘(vi) in the case of the written notification, 
is— 
‘‘(I) signed by such individual (or per-
son acting on the individual’s behalf) to ac-
knowledge receipt of such notification; 
‘‘(II) written and formatted using lan-
guage that is clear and easily understand-
able to Medicare beneficiaries; and 
‘‘(III) made available in different lan-
guages, as specified by the Secretary.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to items and serv-
ices furnished on or after the date that is six months after 
the date of the enactment of this Act. 
Æ 
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