The Centers for Medicare and Medicaid Services (CMS) on October 11 published a final rule establishing 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.

The purpose of the rule is for CMS to comply with a court order issued in the case Alexander v. Azar, a nationwide class action case that established the right of patients to appeal such changes of status.

A retroactive right of appeal will be available to Medicare beneficiaries meeting certain criteria, and both “expedited” and “standard” appeals processes will apply prospectively.  CMS anticipates these processes will be available in early 2025. The appeals processes established by this rule do not extend to enrollees in Medicare Advantage (MA) plans.  A fact sheet is available here.