0938-AV16 202310 The Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Appeal Rights for Certain Changes in Patient Status (CMS-4204)

Pursuant to a court order, this proposed rule would establish new appeals processes for Medicare beneficiaries who have an inpatient hospital admission changed to outpatient by a hospital, and meet other conditions set forth in the order.

]]> Other Significant Previously Published in The Unified Agenda Proposed Rule Stage No No 42 CFR 405 42 CFR 476 42 CFR 489 42 U.S.C. 1395ff Yes

This proposed rule sets forth new appeals processes to implement a court order.  In this order, the Department of Health and Human Services (HHS) is directed to establish appeal process for certain beneficiaries in Original Medicare who are initially admitted to a hospital as an inpatient by a physician but whose status during their stay is changed to outpatient receiving observation services by the hospital, thereby effectively denying Part A coverage for their hospital stay.  

]]>

This rule sets forth new appeals procedures to implement the court order in Alexander v. Azar, 613 F. Supp. 3d 559 (D. Conn. 2020)), aff’d sub nom., Barrows v. Becerra, 24 F.4th 116 (2d Cir. 2022).   The authority for these changes is under various sections of the Social Security Act (the Act).

]]>

None. This rule implements a court order.

]]>

This rule is not considered a significant rule. 

]]>

No risks are anticipated.

]]> NPRM 12/00/2023 No Federal No No No David Danek Health Insurance Specialist 0938 Centers for Medicare & Medicaid Services CMS 410 786-8249 david.danek@cms.hhs.gov Center for Medicare, MS: 2325, 7500 Security Boulevard, Baltimore MD 21244