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 subpara-
graph (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 observa-
tion 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 require-
ments 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 crit-
ical access hospital who presented the written 
notification and includes the name and title of 
such staff member, a certification that the notifica-
tion 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.