In a recent decision, the U.S. District Court in Hartford, Connecticut possibly delivered a new tool for Medicare eligibility based on your hospital admission status in certain specific situations. Under this decision, if you are placed on observation status as opposed to inpatient, you may have the right to appeal your status to Medicare in certain circumstances. As a respected elder care lawyer serving Chester County, PA, and the surrounding areas, Slutsky Elder Law can help explain what this could mean for you.

This ruling is particularly relevant in light of the class-action lawsuit known as Alexander v. Azar was taken to trial in August of 2019 (decision pending). Initially filed by the Center for Medicare Advocacy (CMA), the ruling explores whether that patients whose are on observation status may be able to be converted to inpatient status through a Medicare appeal. The main issue is if whether Medicare Part A or B paying for your hospital stay is an issue of constitutional due process.

Perhaps the most significant benefit to this decision is that certain services may be more affordable for Medicare recipients. Since Medicare only covers patients for rehabilitation in skilled nursing facilities who have been inpatient in the hospital for three or more consecutive nights, the distinction is crucial. Those labeled as outpatient will not be eligible for nursing home coverage at all, which has resulted in Medicare beneficiaries having to pay thousands of dollars out of pocket.

While people with Medicare can appeal virtually any issue affecting their coverage, the Centers for Medicare & Medicaid Service (CMS) has blocked beneficiaries’ attempts to appeal their hospital status. If successful, people can appeal their outpatient status and have a better chance of getting their rehabilitation covered by Medicare.

Slutsky Elder Law focuses on ensuring proper status for older adults receiving all benefits they are entitled to and hopefully this latest decision is a step in the right direction. If you are seeking legal counsel regarding your Medicaid or Medicare, or if you require assistance with Medicaid applications in Montgomery County and beyond, contact us today.

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