Policy & Regulations

Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

Kaiser Health Network
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Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

A win for Medicare seniors seeking nursing home coverage after hospital stays

In this Kaiser Health Network article, you'll learn about:

  • Background behind an appeal for Medicare coverage in nursing home setting

" The Jan. 25 ruling, which came in response to a 2011 class-action lawsuit eventually joined by 14 beneficiaries against the Department of Health and Human Services, will guarantee patients the right to appeal to Medicare for nursing home coverage if they were admitted to a hospital as an inpatient but were switched to observation care, an outpatient service. "

  • Support for the ruling

" Doctors rejected that notion and have long complained that the Medicare rule undermined their clinical judgment and produced “absurd results” that can hurt patients. The American Medical Association and state medical societies filed legal papers in support of the patients challenging the rule, as did several other organizations, including AARP, the National Disability Rights Network, and the American Health Care Association, which represents nursing homes across the country. "

  • Scope of the ruling

" The court’s decision applies only to people with traditional Medicare whose status was changed from inpatient to observation. A hospital services review team can make this change during or after a patient’s stay.

Observation care is a classification designed for patients who are not well enough to go home but still need the kind of care they can get only in a hospital. "

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