On Friday, October 11, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Program: Appeal Rights for Certain Changes in Patient Status rule, which established court-ordered appeals processes for Medicare beneficiaries admitted as hospital inpatients but later reclassified as outpatients receiving observation services during their hospital stay. The final rule stayed largely as proposed but offers expanded timelines and additional beneficiary protections, which AHCA/NCAL advocated for and supports as part of its coalition efforts.
AHCA/NCAL has developed a summary of the final rule for members. Please note an AHCA/NCAL log-in is required to view the summary.
Medicare beneficiaries should have the right to appeal and ensure they are not denied their needed skilled nursing benefits. While this final rule will be helpful, AHCA/NCAL continues to urge Congress to resolve this issue permanently by eliminating the three-day-stay requirement or recognizing observation days in the determination of SNF benefit eligibility. AHCA/NCAL has long advocated for counting observation stays towards the three-day stay requirement or waiving the three-day stay requirement all together.
Additionally, AHCA/NCAL continues to be a strong supporter of the bipartisan and bicameral Improving Access to Medicare Coverage Act (S. 4137/H.R. 5138). This bill would help Medicare beneficiaries who are hospitalized in observation by requiring that time spent in observation be counted towards meeting the three-day prior inpatient stay. AHCA/NCAL, along with the Center for Medicare Advocacy, spearheads a coalition effort consisting of 35 national organizations advocating for this bill.