As a result of the Center for Medicare Advocacy’s successful litigation, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on December 21, 2023, to implement appeals processes for hospital patients whose status is changed from inpatient to observation. The appeals will open the door to medically necessary services in nursing homes that many have had to forego, or pay thousands of dollars for, due to their observation status classification.
The proposed rule establishes both standard and expedited appeals for Medicare beneficiaries who are class members in Alexander v. Azar. Class counsel is pleased that CMS released the proposed rule and is reviewing it with the expectation of submitting comments. “The proposed rule brings Medicare beneficiaries one step closer to getting a fair shake if they are changed from inpatient to observation status.” said Alice Bers, Litigation Director of the Center for Medicare Advocacy.
The proposed rule will be published in the Federal Register and open for public comments for 60 days starting on December 27, 2023. The Center for Medicare Advocacy, Justice in Aging, and Wilson Sonsini Goodrich & Rosati won the trial in Alexander v. Azar in 2020 in federal district court in Hartford, Connecticut. The decision was upheld in its entirety by the U.S. Court of Appeals for the Second Circuit in 2022.
- Read the proposed rule: https://public-inspection.federalregister.gov/2023-28152.pdf
- For more information about the class action, including information for people who think they may be members of the class, read the Frequently Asked Questions about the case: https://medicareadvocacy.org/frequently-asked-questions-about-the-observation-status-court-decision/
The Center for Medicare Advocacy (http://www.medicareadvocacy.org) is a national, non-profit, law organization that works to advance access to comprehensive Medicare coverage, health equity, and quality health care for older people and people with disabilities. Founded in 1986, the Center focuses on the needs of people with longer-term and chronic conditions. The organization’s work includes legal assistance, advocacy, education, analysis, policy initiatives, and litigation of importance to Medicare beneficiaries nationwide. Our systemic advocacy is based on the experiences of the real people who contact the Center every day.