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, which establishes an appeals process 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.

The proposed rule offers additional beneficiary protections to assure the three-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 summarized the proposed rule. It’s available to members using their AHCA login. Along with a coalition of 34 national provider and beneficiary advocate organizations, AHCA/NCAL is endorsing H.R. 5138 Improving Access to Medicare Coverage Act. The bill aims to help Medicare beneficiaries who are hospitalized in observation by requiring that time spent in observation count towards meeting the three-day prior inpatient stay.