The Medicare discharge clock: your rights, hour by hour
When a hospital or a skilled-nursing facility says a Medicare-covered stay is ending, a short set of federal deadlines starts running. They are real, they are yours, and they are measured in hours. This page gives you each one in the regulation’s own words, with the citation, so you can point to the sentence itself.
One honest note before the clocks: These clocks govern how long Medicare keeps paying for the current stay. They do not decide where anyone moves next — that choice stays with the family. There is no deadline on choosing well.
What must the hospital give me, and when?
A standardized written notice of your rights as a hospital inpatient — Medicare calls it the “Important Message from Medicare” (IM). The timing is fixed:
“The hospital must provide the notice at or near admission, but no later than 2 calendar days following the beneficiary’s admission to the hospital.”
And you get a copy again before you leave: the hospital must present the signed notice “as far in advance of discharge as possible, but not more than 2 calendar days before discharge” (42 CFR §405.1205(c)). Keep it — the phone number for the independent reviewer (the QIO, a Quality Improvement Organization under contract to Medicare) is printed on that notice.
What if I think the discharge date is too soon?
You can ask the QIO for an expedited review. A phone call counts, and the deadline is the day of discharge itself:
“The request must be made no later than the day of discharge and may be in writing or by telephone.”
Once you request it, the hospital owes you a detailed written explanation quickly — “as soon as possible but no later than noon of the day after the QIO’s notification” (42 CFR §405.1206(e)(1)) — and the QIO must decide within one calendar day after it has the records it needs (42 CFR §405.1206(d)(6)(i)).
Who pays for the hospital days while the review runs?
Not you, in the window the regulation protects:
“If a beneficiary files a request for an expedited determination by the QIO in accordance with paragraph (b)(1) of this section, the beneficiary is not financially responsible for inpatient hospital services (other than applicable coinsurance and deductible) furnished before noon of the calendar day after the date the beneficiary (or his or her representative) receives notification (either orally or in writing) of the expedited determination by the QIO.”
Glossed: request the review on time, and your protection from hospital charges runs until noon of the day after the QIO’s answer reaches you — your normal coinsurance and deductible still apply.
What about a skilled-nursing facility, home health, or hospice?
The same machinery exists for what Medicare calls provider services — the regulation defines the covered settings as “a home health agency (HHA), skilled nursing facility (SNF), comprehensive outpatient rehabilitation facility (CORF), or hospice” (42 CFR §405.1200(a)). The notice comes first:
“A provider must notify the beneficiary of the decision to terminate covered services no later than 2 days before the proposed end of the services.”
Your request deadline is tighter here — the QIO must hear from you “by no later than noon of the calendar day following receipt of the provider’s notice of termination” (42 CFR §405.1202(b)(1)) — and the QIO then has 72 hours from your request to decide (42 CFR §405.1202(e)(6)). While it decides, the regulation keeps the default in place:
“Coverage of provider services continues until the date and time designated on the termination notice, unless the QIO reverses the provider’s service termination decision.”
On a Medicare Advantage plan, parallel rights exist with the same shape — notice, fast review, protected window (42 CFR §§422.620–422.626). The plan’s notice names the reviewer to call.
What should we actually do in the next 72 hours?
- Ask the discharge planner for everything in writing: the notice above, the proposed date, and the care-needs assessment.
- If the date feels wrong, call the QIO number on your notice the same day. It costs nothing, and the deadlines above protect you while it runs.
- Start the housing search in parallel — the review buys days, not weeks. Search every licensed care home near you, free, from the state’s own records, or check specific homes a planner suggested.
- Call homes yourself, or ask us to confirm beds and prices for you — free either way, and only homes you name ever hear from us.
- Visit before signing. You’re entitled to a blank admission agreement from any home on request (Health & Safety Code §1569.881).
Handing this to a family at a discharge desk? A one-page printable version lives at /print/handout — it dates itself each time you print it.
Where does this come from?
Every quoted sentence above is the federal regulation verbatim — 42 CFR Part 405, Subpart J (§§405.1200–405.1206), readable in full at Cornell Law’s CFR text. We add the citations and the plain-language glosses, and nothing else. This is public-record information, not legal advice; a hospital ombudsman, HICAP counselor, or elder-law attorney can advise on your specific case.