CMS Issues Proposed Rule on Beneficiary Appeal Process for Reclassified Hospital Stay

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on December 27, 2023, Medicare Program: Appeal Rights for Certain Changes in Patient Status, which establishes appeals processes for Medicare beneficiaries whose inpatient hospital stays were later reclassified to outpatient receiving observation services. Comments on the proposed rule are due February 26, 2024.

This proposed rule offers additional beneficiary protections to assure the 3-day qualifying hospital stay requirement to access the Medicare Part A skilled nursing facility (SNF) benefit has been met. This appeal process will help Medicare beneficiaries access the SNF benefit prospectively and retrospectively.

AHCA/NCAL has developed a summary of the proposed rule available to members (log-in required). Please contact Martin Allen with any questions.

AHCA/NCAL supports CMS' aim in the proposed rule. The Association has long advocated for counting observation stays towards the three-day stay requirement or waiving the three-day stay requirement all together. One bill AHCA/NCAL is endorsing – along with a coalition of 34 national provider and beneficiary advocate organizations – is the bipartisan H.R. 5138 Improving Access to Medicare Coverage Act. It 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. Please contact Dana Ritchie to learn more about the observation stays coalition and advocacy efforts.
Staff contact: