View Rule

View EO 12866 Meetings Printer-Friendly Version     Download RIN Data in XML

HHS/CMS RIN: 0938-AV16 Publication ID: Fall 2023 
Title: 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.

Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 405    42 CFR 476    42 CFR 489   
Legal Authority: 42 U.S.C. 1395ff   
Legal Deadline:  None

Statement of Need:

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.  

Summary of the Legal Basis:

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.

Anticipated Costs and Benefits:

This rule is not considered a significant rule. 


No risks are anticipated.

Action Date FR Cite
NPRM  12/00/2023 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
David Danek
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare, MS: 2325, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-8249