From DC: Medicare Hospital Observation Status Appeals Process, Report on Housing & Health Needs of Older Adults Experiencing Homelessness, and more

Here’s what we’re watching in Washington:

CMS Issues Final Rule Establishing Medicare Hospital Observation Status Appeals

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) published a long-awaited final rule to establish appeals processes for certain Medicare enrollees who were initially admitted as hospital inpatients but later reclassified as outpatients receiving observation services. The rule implements the District Court of Connecticut’s 2020 order in Alexander v. Azar, a nationwide class action lawsuit brought by the Center for Medicare Advocacy, Justice in Aging, and pro bono law firm Wilson Sonsini Goodrich & Rosati seeking appeal rights for people on hospital observation.

Patients classified as observation status cannot access Medicare coverage of nursing facility services. Instead, they must either pay out-of-pocket or forgo medically necessary nursing facility services altogether. With the new appeals, Medicare enrollees will have the opportunity to challenge their observation status designation.

Learn more in our comments on the proposed rule and the Center for Medicare Advocacy’s announcement on the final rule. We will be providing more analysis and resources for advocates before the appeals processes are operationalized early next year and look forward to working with CMS and advocates to ensure that Medicare enrollees understand and can easily access their new appeal rights.

GAO Releases Report with Actions to Address Housing & Health Needs of Older Adults Experiencing Homelessness

The Government Accountability Office has issued a report on the causes, experiences of homelessness among older adults, and potential solutions. Nationwide, there are about 138,000 older adults (age 55+) who were counted in the January 2023 Point in Time count. The risk of entering homelessness is greater for Black, Latino/Latina, and Indigenous adults.

Older adults often have specific health conditions, mobility limitations, and functional impairments that the homeless service system is not equipped to meet. The report contains specific recommendations about how to address the particular needs of older adults, including integrating home and community-based services and physically accessible spaces.

The full report can be found here: Homelessness: Actions to Help Better Address Older Adults’ Housing and Health Needs.

Medicare Open Enrollment Started October 15

Medicare Open Enrollment began October 15 and will close on December 7. This is an important opportunity for Medicare enrollees to review and change their coverage. There are a number of changes happening in 2025 that advocates working with low-income older adults should know about when counseling their clients this year.

Starting in January 2025, there will be two new Special Enrollment Periods (SEPs) available to low-income enrollees. These new SEPs will affect when individuals can modify their Medicare Advantage coverage. Also effective in January 2025, the Inflation Reduction Act will limit Medicare Part D out-of-pocket prescription costs to $2,000 annually.

Lastly, many low-income enrollees lost Medicaid over the last two years due to the public health emergency. These individuals may need to reapply for the Low-Income Subsidy (“Extra Help”) with the Social Security Administration in order to avoid having to pay for prescription drug out-of-pocket costs or choose a different Medicare Advantage or Part D plan to avoid higher costs. Read more in our blog.

New Justice in Aging Resources

Upcoming Justice in Aging Webinars

Justice in Aging Webinar Recordings

New from the National Center on Law & Elder Rights (NCLER)

On October 23^rd, NCLER will present a training on Legal Basics: Medicaid Long-Term Services and Supports (LTSS). This webinar will cover the basics of Medicaid LTSS eligibility for nursing home residents and home and community-based services (HCBS) enrollees. Attendees will better understand the different ways in which states cover HCBS and protections available to all LTSS beneficiaries. Learn more and register for the webinar.

Read NCLER’s recent Guardianship Awareness Resource Guide, created in partnership with the National Center on Elder Abuse. The guide has links to helpful guardianship trainings, podcasts, publications, and tips on alternatives to guardianship.