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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.

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).

Alternatives:

None. This rule implements a court order.

Anticipated Costs and Benefits:

This rule is not considered a significant rule. 

Risks:

No risks are anticipated.