CMS on December 21st released an advanced copy of a proposed rule that would establish appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpatients but are subsequently reclassified as outpatients receiving observation services during their hospital stay. This proposal is significant because a change of status may affect cost sharing for the hospital stay as well as whether any post hospital care in a skilled nursing facility would be covered by Medicare.
By issuing the proposal, CMS intends to comply with a court order issued in the case Alexander v. Azar, a nationwide class action case filed by the Center for Medicare Advocacy that established the right of patients to appeal for such changes of status. A retroactive right of appeal would be available to Medicare beneficiaries meeting certain criteria, and both “expedited”, and “standard” appeals processes would apply prospectively. The appeals processes proposed in this rule do not extend to enrollees in Medicare Advantage (MA) plans. LeadingAge will analyze the proposed rule and provide additional information for members.
