LeadingAge joined a coalition of almost 30 stakeholders in submitting a February 26 comment letter on the Centers for Medicare & Medicaid Services (CMS) proposed rule implementing appeal rights for Medicare beneficiaries who are admitted to hospitals as inpatients and subsequently reclassified as outpatients receiving observation services.

This proposed rule is significant because a change of status may affect cost sharing for hospital stays, as well as whether any post hospital care in a skilled nursing facility would be covered by Medicare. By issuing this proposed rule, CMS intends to comply with a court order issued in the court case of 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 would be available to Medicare beneficiaries meeting certain criteria, and both “expedited” and “standard” appeals processes would apply prospectively.

The comment letter supports the general approach to the retrospective and prospective appeals processes and urges CMS to finalize and implement the rule as soon as possible. The letter also urges CMS to address the issue of observation stays more broadly for all Medicare beneficiaries by counting all time in the hospital towards satisfying the three-day inpatient requirement.  In fact, the letter includes specific information that sets out CMS’s legal authority to make this broader change to the three-day inpatient policy.