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Hospital Discharge

Dear Advocate,

My mother suffered a stroke and is in the hospital. She is on Medicare. The hospital is telling me she must be discharged now, but I don’t think she is ready and I haven’t had time to locate a skilled nursing facility where she can receive the therapy she needs. Does my mother have any rights to stay in the hospital?

Upset in Upland

Dear Upset:

Yes, hospitalized Medicare beneficiaries have the right to receive the medical care they need. These rights are explained in a notice called “An Important Message from Medicare” that hospitals must give patients (or their representatives) when they are admitted and before they are discharged.

You can appeal the hospital’s discharge decision. On July 1, 2007, new Medicare appeal procedures took effect. You can file an appeal by calling Lumetra (a private organization working under contract with Medicare) at 1–800–841–1602. If you file your appeal anytime before you are discharged, you can stay in the hospital and Medicare will continue to cover your stay at least until the day after Lumetra issues its decision.

Hospitals cannot discharge Medicare patients if they need skilled nursing facility services but a bed is not available in their area. Medicare covers hospital stays until a skilled nursing facility bed is located.

For more information, see CANHR’s updated fact sheet, Challenging Hospital Discharge Decisions. The new Medicare appeal regulations are found at 42 CFR Part 405, Subpart J, 42 CFR §§ 422.620 – 422.622, and 42 CFR §489.27.