Medicare Observation Status Appeals Are In Effect
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 been 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
Contact a certified elder law attorney(*), such as Linda Strohschein and her team at Strohschein Law Group for assistance. To set up an appointment, contact Strohschein Law Group at 630-300-0627.
This information provided by Strohschein Law Group is general in nature and is not intended to be legal advice, nor does it constitute a legal relationship. Please consult an attorney for advice regarding your individual situation.
(*) The Supreme Court of Illinois does not recognize certifications of specialties in the practice of law and the CELA designation is not a requirement to practice law in Illinois.
Article provided by A. BERS of The Center for Medicare Advocacy