Beneficiaries are seeing information about “a new appeal right” on the Medicare Summary Notices they receive in the mail. This right resulted from the Center for Medicare Advocacy’s class action on behalf of beneficiaries who have harmed by “observation status,” litigated with Justice in Aging and Wilson Sonsini Goodrich & Rosati. The appeals allow certain hospital patients who are reclassified from inpatient to observation to challenge their status and potentially gain Medicare coverage of skilled nursing facility services.
Retrospective appeals are available for class members who did not have an appeal process available at the time they were in the hospital or nursing home. They cover hospitalizations that occurred from January 1, 2009 – February 13, 2025, and requests for such appeals must be submitted by January 2, 2026. Prospective appeals, which took effect permanently as of February 14, 2025, are for class members who are in the hospital and wish to appeal their reclassification from inpatient to observation. These beneficiaries may be able to qualify for a Medicare-covered nursing home stay if they win their appeal.
For more information about who is eligible and how to appeal, see:
- Frequently Asked Questions about the “Observation Status” Court Decision
- Recorded Webinar on Observation Status Appeals with slides and additional resources
- Observation Status Appeals Resources
- Request for Retrospective Appeal Form
- Medicare Change of Status Notice
February 20, 2025 – A. Bers