Patient Right to Appeal Discharge

Hi, I don't know anything about this, but I am interested in learning more about this. How do they appeal? Can they say that "I am not ready because of x,y,z" and a different committee including or not including the original discharging MD reviews the case, and they say "ok you can stay" or "no, it's time to go."

All states have laws for the right to appeal a discharge. every state has an agency designated for appeals. (Called a QIO-Quality I? Organization) I forget what the I stands for. Every patient (or representative, like POA) is supposed to sign that they acknowledge they have this right. Hospital patients sign it on admission, and nursing home (rehab) patients receive a 48 hour notice that they are being discharged, with appeal instructions printed on the notice.

For Home Health: If services are provided, but not paid, the client can appeal. That is why TX, where I work, requires a 48 hour notice of discharge from HH services. Sometimes the agency provides care, knowing that there may not be compensation. The theory is to not "drop the patients" without a provider. If my agency plans to discharge a patient, they have to provide written notice and evidence of discharge planning for patient care continuity 48 hours prior to discharge, by state law, 5 day notice by medicare.

This has been in effect in CA for over a year (feels like it if not..) where the patients have the right to appeal their discharge. Upon admission, all Medicare and senior managed care (Mcare elig) patients are given the Important Message from Medicare. They are provided with very clear instructions what to do if they think they are being discharged from the hospital too soon. They also must be provided this letter of acknowledgement 48 hours prior to discharge so they can have time to "think". If it is not given 48 hrs prior to discharge, it has to be presented 4 hours before discharge and they have that time frame to decide if they want to go home. If they appeal their discharge and call HSAG or Lumetra etc, their discharge is stopped. The whole chart has to be sent to them for review. A physician will make the decision whether the patient is ready for discharge. The patient has 3 days while waiting, and if the MD reviewer agrees with the hospital, the patient is discharged on the 4th day by noon. We give the letter to the patients on M-W-F to make sure we comply with the time frame as specified. We try and downplay having it signed so the patients don't panic at the thought of being discharged too soon. Of course if someone is critical, it isn't signed every other day! Hope this helps.

I can't answer that question, but there is a customer service number for every patient's own insurance that they have the right to call. We have had HMO patients refuse to be discharged and go that route, but the Patient Right to Appeal Discharge pertains to Medicare and Sr advantage patients (signed over benefits to a senior HMO) in Ca.