Follow ACMA
Twitter Facebook Linkedin Twitter
v
GO
Updates & Calls to ActionSupport AdvocacyMake Giving Tuesday Donation
PUBLIC POLICY UPDATES

“Observation Status” Policy Moving Through Court System


Posted on: 11/28/2017

The hospital administration policy fight over “Observation Status” versus “Inpatient Status” may finally hit a boiling point this year. In July, the United States District Court of Connecticut ruled in favor of Medicare beneficiaries seeking administrative review of their “observation status.” In Alexander v. Price, 3:11-CV-1703, U.S. District Court Judge Michael Shea certified a class of individuals who are now eligible to sue the U.S. Department of Health and Human Services for the right to challenge the arbitrary label. Those eligible to join the suit against the Department are all Medicare beneficiaries who, on or after January 1, 2009: (1) have received or will have received “observation services” as an outpatient during a hospitalization; and (2) have received or will have received an initial determination that the observation services are covered (or subject to coverage) under Medicare Part B are eligible to join the class-action suit.

According to documentation filed in the case, the number of class members may well reach into the hundreds of thousands. The court cited a Brown University study originally published in 2012 that identified over 900,000 Medicare beneficiaries who experienced “observation status” hospital stays in 2009. The plaintiffs in the case argued that classification under “observation status” rather than “inpatient status” results in higher out-of-pocket costs during and after hospital stays. During the hospital stay, patients under “observation status” face higher costs for drugs and copayments for hospital services. After the hospital stay, patients could face astronomical expenses for skilled nursing facility care.

Click here to read the court decision.

Click here to visit the Center for Medicare Advocacy, the lead organization in representing the plaintiffs.

Return to Legislative Postings

Announcements

Compass 2019 is Coming Soon: Save by December 31

Build a competent and confident care team with Compass training for 2019! This comprehensive program is designed to standardize onboarding and competency validation for case managers and physician advisors. New courses include an introduction to health plan case management, ethics and scenarios for continuum-based care. Courses are now designated as “Core” or “Specialty” to highlight learning applicable to case managers in multiple settings across the continuum of care, with additional learning focused on the unique needs of specific specialties, such as pediatrics, health plans and advanced/leadership training. Purchase upgrade or learn more today>>>.

ACMA Legislative Campaign: Close the Medicare Observation Coverage Gap

We need your help! Raise your voice in support of the "Increasing Access to Medicare Coverage Act" and our campaign to close the observation status coverage gap in Medicare.
Take Action    Sign the Petition!

Save the Date: 2019 Leadership and Physician Advisor Conference

The 2018 Leadership and Physician Advisor Conference took place early November in Huntington Beach, California! Case management leaders and physician advisors from across the country gathered to collaborate, network and move case management forward. Follow #ACMAleadership on social media to see all the action that took place. We hope you'll join us next year, November 14-17, 2019 in Miami, Florida!

New Simulation Program for Value-Based Results

ACMA leads the practice by introducing Advanced Care Transitions Simulation (ACTS). This simulation program will transform orientation and professional development for your case management team. ACTS is focused on improving care transitions through assessment, communication, planning and collaboration. It leverages unique, team-based simulations of patient scenarios and enhances care coordination and critical thinking. Enhance case management and impact your system with ACTS. >>>

Kick Off the Giving Season with Giving Tuesday

You advocate every day on behalf of your patients and their families. Join us with #GivingTuesday to help support ACMA's advocacy efforts for proper legislation, policies and regulations that will positively impact your practice and patients. #GivingTuesday is a global annual event celebrated on the Tuesday after Thanksgiving. Let's see how much we can raise by November 27 this year! Donations can be made through the end of November. Donate Today >>>

Congress Passes Opioid Bill, President to Sign

Great news from Washington! With your support, Congress took a historic step in the fight against the opioid epidemic. On Wednesday, October 4, Congress approved the comprehensive opioids response package, sending the bill to President Trump for his signature and enactment into law. Read more here >>>

American Case Management Association
11701 W. 36th St.
Little Rock, Arkansas 72211
Phone: 501-907-ACMA (2262)
Fax: 501-227-4247