Court Upholds Right to Appeal for Certain Medicare Beneficiaries on “Observation Status”

On January 25, 2022, a federal appeals court decided that Medicare must provide appeal procedures for hospitalized beneficiaries who are reclassified from inpatients to “outpatients” receiving “observation services.” The observation designation can have severe ramifications, including non-coverage of nursing home care. A nationwide class of Medicare beneficiaries won the right to appeal at a trial held in 2019. The class is represented by the Center for Medicare Advocacy, Justice in Aging, and pro bono firm Wilson Sonsini Goodrich and Rosati. The federal government appealed the trial decision in 2020.

• Read the appeals court decision here.
• Read our full statement on the decision here.
• For more information about the case, including who is included in the class, please read the Center for Medicare Advocacy’s frequently asked questions.