[Sarcastic graphic omitted, but the temptation was almost too much] CMS is predicting an effective implementation date of October 1, 2016 for its new requirement that you “MOON” observation patients — or just as soon as its proper form of MOONing completes the public comment process (and any revisions). I really don’t know who comes up with the names for these things, but here is the CMS explanation:
Enacted August 6, 2015, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires hospitals and Critical Access Hospitals (CAH) to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status.
Hospitals and CAHs are required to furnish a new proposed CMS-developed standardized notice, the Medicare Outpatient Observation Notice (MOON), to a Medicare beneficiary who has been receiving observation services as an outpatient for more than 24 hours. Under the final rule, hospitals and CAHs may deliver the MOON to individuals receiving observation services as an outpatient before such individuals have received more than 24 hours of observation services. The notice must be provided no later than 36 hours after observation services are initiated or, if sooner, upon release;
The MOON will inform more than one million beneficiaries annually of the reason(s) they are an outpatient receiving observation services and the implications of such status with regard to Medicare cost sharing and coverage for post-hospitalization skilled nursing facility (SNF) services; and
An oral explanation of the MOON must be provided, ideally in conjunction with the delivery of the notice, and a signature must be obtained from the individual, or a person acting on such individual’s behalf, to acknowledge receipt. In cases where such individual or person refuses to sign the MOON, the staff member of the hospital or CAH providing the notice must sign the notice to certify that notification was presented.
The standardized notice, the MOON, is going through the Paperwork Reduction Act process, thus affording the public an opportunity to comment on the MOON. The 30-day public comment period begins when the final rule is published.
COMMENT: I would not be surprised to see actual implementation of the form delay this rule into 2017.
I don’t think there will be a delay. If there is, it will be a month or less. CMS already made major changes to the MOON in response to the first set of comments and is unlikely to make more changes. The public comment period will end Sept 1 and then it goes to OMB for approval which should occur quickly. So Oct 1 for implementation is realistic. But hospitals will then have 90 days to implement (which is Jan 1, 2017) so technically your 2017 prediction could be viewed as correct.
I don’t think Medicare is getting it yet. Telling the patient about Obs Status after they have been admitted is like shutting the barn door after the horse is out. The patient should be informed of this status before they are put in Obs. They only way a patient can make an informed decision that is best for them is to be made aware of all the financial ramifications before they are moved. Many patients on Medicare cannot afford all of the extra costs that go along with Obs.
Admitting the patient to Obs and then telling them as they are being released, “Oh, by the way, you weren’t really admitted to the hospital and your costs for this stay are going to be much greater than if you had been admitted”, is not fair. Patients should know the extra financial burden before being admitted.