Can we appeal a hospital discharge on Medicare?
Yes. In California, ask Medicare’s reviewer, Commence Health (1-877-588-1123), for a fast review no later than the day of discharge, by phone or in writing. 42 CFR §405.1206(b)(1)
Checked against the federal rules (42 CFR), Medicare.gov and CMSHow we check
- The deadline
- No later than the day of discharge. A phone call counts.
- Who pays meanwhile
- If you ask on time, the patient is not charged for the extra hospital days until noon of the day after the reviewer answers, apart from the usual deductible and coinsurance.
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.
Checked against the federal rules (42 CFR), Medicare.gov and CMSHow we check
Check your appeal deadline
Answer a few questions about the notice you have. You’ll see when to call Medicare’s reviewer, to the day and hour, and what protects the patient while it decides.
Your answers stay on this page. We don’t save or send them.
The rules this check uses
The law’s own words, with the day we last checked each one.
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.
The hospital must present a copy of the signed notice described in paragraph (b)(2) of this section to the beneficiary (or beneficiary's representative) prior to discharge. The notice should be given as far in advance of discharge as possible, but not more than 2 calendar days before discharge.
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. If the beneficiary's services are expected to be fewer than 2 days in duration, the provider must notify the beneficiary at the time of admission to the provider. If, in a non-residential setting, the span of time between services exceeds 2 days, the notice must be given no later than the next to last time services are furnished.
A beneficiary who wishes to exercise the right to an expedited determination must submit a request to the QIO that has an agreement with the hospital as specified in § 476.78 of this chapter. The request must be made no later than the day of discharge and may be in writing or by telephone.
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.
When the beneficiary requests an expedited determination in accordance with paragraph (b)(1) of this section, the QIO must make a determination and notify the beneficiary, the hospital, and physician of its determination within one calendar day after it receives all requested pertinent information.
A beneficiary who fails to make a timely request for an expedited determination by a QIO, as described in paragraph (b)(1) of this section, and remains in the hospital without coverage, still may request an expedited QIO determination at any time during the hospitalization. The QIO will issue a decision in accordance with paragraph (d)(6)(ii) of this section, however, the financial liability protection under paragraphs (f)(1) and (f)(2) of this section does not apply.
When a beneficiary does not file a request for an expedited determination by the QIO in accordance with paragraph (b) of this section, but remains in the hospital past the discharge date, that beneficiary may be held responsible for charges incurred after the date of discharge or as otherwise stated by the QIO.
A beneficiary who fails to make a timely request for an expedited determination in accordance with paragraph (b)(1) of this section, and who is no longer an inpatient in the hospital, may request QIO review within 30 calendar days after the date of discharge, or at any time for good cause. The QIO will issue a decision in accordance with paragraph (d)(6)(iii) of this section; however, the financial liability protection under paragraphs (f)(1) and (f)(2) of this section does not apply.
A beneficiary who wishes to exercise the right to an expedited determination must submit a request for a determination to the QIO in the State in which the beneficiary is receiving those provider services, in writing or by telephone, by no later than noon of the calendar day following receipt of the provider's notice of termination. If the QIO is unable to accept the beneficiary's request, the beneficiary must submit the request by noon of the next day the QIO is available to accept a request.
A beneficiary who receives a NOMNC and disagrees with the termination of services may request an expedited determination by the appropriate QIO for the state where the services were provided. The beneficiary must contact the QIO by noon of the day before the effective date on the NOMNC. The beneficiary may contact the QIO by telephone or in writing. If the QIO is unable to accept the request, the beneficiary must submit the request by noon of the next day the QIO is available.
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. If the QIO's decision is delayed because the provider did not timely supply necessary information or records, the provider may be liable for the costs of any additional coverage, as determined by the QIO in accordance with paragraph (e)(7) of this section. If the QIO finds that the beneficiary did not receive valid notice, coverage of provider services continues until at least 2 days after valid notice has been received. Continuation of coverage is not required if the QIO determines that coverage could pose a threat to the beneficiary's health or safety.
No later than 72 hours after receipt of the request for an expedited determination, the QIO must notify the beneficiary, beneficiary's physician, and the provider of services of its determination whether termination of Medicare coverage is the correct decision, either on the basis of medical necessity or based on other Medicare coverage policies.
If a beneficiary makes an untimely request for an expedited determination by a QIO, the QIO will accept the request and make a determination as soon as possible, but the 72-hour time frame under paragraph (e)(6) and the financial liability protection under paragraph (g) of this section do not apply.
If the beneficiary makes an untimely request to the QIO, the QIO will accept the request for review, but is not required to complete the review within its usual 72-hour deadline. The QIO will make a determination as soon as possible upon receipt of the request. Beneficiaries have up to 60 days from the effective date of the NOMNC to make an untimely request to a QIO. When the beneficiary is still receiving services, the QIO must make a determination and notify the parties within 7 days of receipt of the request. When the beneficiary is no longer receiving services, the QIO will make a determination within 30 days of the request.
The coverage protections discussed in 260.4.2 do not apply to a beneficiary who makes an untimely request to the QIO.
A beneficiary must obtain a physician certification stating that failure to continue home health or CORF services is likely to place the beneficiary's health at significant risk. Without such a certification statement a QIO may not make a determination for service terminations in these settings.
The physician certification is a written statement from any licensed physician contacted by a beneficiary. This is a special certification required only in this expedited determination process for expedited determinations in home health and CORF settings.
A beneficiary may request an expedited determination from a QIO before obtaining this certification of risk. Once the QIO is aware of a review request, it will instruct the beneficiary on how to obtain the necessary certification from a physician.
What notice must the hospital give?
The hospital must give the patient a written notice of their rights, the “Important Message from Medicare”. It comes within 2 days of admission. 42 CFR §405.1205(b)(1) The patient gets a copy again before they leave, no more than 2 days before discharge. 42 CFR §405.1205(c)(1)
Keep the notice. The reviewer’s phone number is printed on it.
How do we ask for a review, and what do we say?
Call the reviewer on the notice, or Commence Health, 1-877-588-1123. (Commence Health) Ask no later than the day of discharge, and before the patient leaves the hospital.
“A beneficiary who wishes to exercise the right to an expedited determination must submit a request to the QIO that has an agreement with the hospital as specified in § 476.78 of this chapter. The request must be made no later than the day of discharge and may be in writing or by telephone.”
“I’m asking for a fast appeal of a hospital discharge for [name] at [hospital]. The planned discharge date is [date].”
Once you ask, the hospital must give the patient a detailed written reason by noon the next day. 42 CFR §405.1206(e)(1) The reviewer decides within one day of getting the records it needs. 42 CFR §405.1206(d)(6)(i)
Who pays while it’s reviewed?
If you ask on time, the patient is not charged for hospital days until noon of the day after the reviewer’s answer reaches you. The usual deductible and coinsurance still apply. 42 CFR §405.1206(f)(2)
What if we missed the deadline?
The patient can still ask. While in the hospital, they may ask at any time. 42 CFR §405.1206(b)(5) After they have left, they may ask within 30 days. 42 CFR §405.1206(b)(6) In both cases the protection from charges does not apply. 42 CFR §405.1206(f)(3)
What if the patient is “under observation”?
A patient under observation is an outpatient, not an inpatient, even overnight. After more than 24 hours under observation, the hospital must give them a written notice, the MOON. It must arrive no later than 36 hours after observation began. 42 CFR §489.20(y)
Days under observation do not count toward the 3 inpatient days Medicare needs before it pays for a skilled nursing facility. (Medicare.gov, 2026) If the hospital changes the patient from inpatient to observation, they may be able to appeal. (Medicare.gov)
What about a nursing facility, home health or hospice?
These services must give written notice at least 2 days before Medicare coverage ends. 42 CFR §405.1200(b)(1) The notice is the “Notice of Medicare Non-Coverage”.
The deadline to ask the reviewer has two wordings, so call by the earlier:
- the federal rule: noon of the day after the patient got the notice;
“A beneficiary who wishes to exercise the right to an expedited determination must submit a request for a determination to the QIO in the State in which the beneficiary is receiving those provider services, in writing or by telephone, by no later than noon of the calendar day following receipt of the provider's notice of termination. If the QIO is unable to accept the beneficiary's request, the beneficiary must submit the request by noon of the next day the QIO is available to accept a request.”
42 CFR §405.1202(b)(1)Read it on the Electronic Code of Federal RegulationsChecked October 21, 2026 - the notice and Medicare’s manual: noon of the day before the end date printed on the notice. CMS Claims Manual, ch. 30, §260.4.1.1
Medicare keeps paying until the date and time on the notice while the reviewer decides. 42 CFR §405.1202(c) The reviewer answers within 72 hours. 42 CFR §405.1202(e)(6)
A late request is still taken, without the 72-hour answer or the protection from charges. 42 CFR §405.1202(b)(4) Medicare’s manual allows up to 60 days after the end date. CMS Claims Manual, ch. 30, §260.4.3 For home health, the reviewer also needs a doctor’s statement; you can call before you have it. CMS Claims Manual, ch. 30, §260.4.1.3
The patient does not have to be getting better for Medicare to keep paying a skilled nursing facility. It covers care that improves their condition, maintains it, or slows its decline. (Medicare.gov, 2026)
How long will Medicare pay in a nursing facility?
After at least 3 days as a hospital inpatient, up to 100 days. 42 CFR §409.30(a)(1)
- Days 1–20
- $0, after the $1,736 deductibleMedicare.gov, 2026
- Days 21–100
- $217 a dayMedicare.gov, 2026
- Day 101 on
- All costsMedicare.gov, 2026
What about a Medicare Advantage plan?
The same notices and fast reviews apply. The notice the patient gets names who to call, and what to do if the deadline has passed.
What should we do in the next 72 hours?
Step 1: Ask for the notice in writing
Today
Ask the discharge planner for the notice, the planned date and the patient’s care needs in writing.
Step 2: Call the reviewer if the date feels too soon
Today
If the date feels too soon, call the reviewer. It costs nothing.
Step 3: Look for the next place to live
Now, at the same time
Look for the next place to live. A review buys days, not weeks.
Step 4: Ask for the medical assessment
Before any move to a care home
The person moving needs a medical assessment made within the last year, on the state’s form LIC 602A. Ask the hospital doctor for it now. Title 22 §87458(a) (CDSS notice, May 2025)
Step 5: Ask for a blank admission agreement
Before signing
Every care home must give you a blank copy of its admission agreement. Health and Safety Code §1569.881(a)
Handing this to a family at a discharge desk? Print the one-page version ›
Free help with Medicare questions: HICAP, 1-800-434-0222. (Dept. of Aging)
Questions families ask · 5
Can a hospital discharge a patient with nowhere to go?
You can ask Medicare’s reviewer to look at the discharge before the patient leaves. If you ask on time, the patient is not charged for the extra days while it reviews.
How do I appeal a hospital discharge in California?
Call Commence Health, 1-877-588-1123, or the number on the “Important Message from Medicare”, no later than the day of discharge.
Does observation count toward the 3 days?
No. Only days as an admitted inpatient count.
Will Medicare pay for a nursing home after the hospital?
For up to 100 days of skilled care, after a qualifying hospital stay, with a daily charge from day 21. It does not pay for living in a care home.
What is a QIO?
Medicare’s independent reviewer for each state. In California it is Commence Health, formerly Livanta.
There is no deadline on choosing well.
Next, step 1 of 6: Learn the kinds of care homes
- Assisted living vs. nursing home
In California, assisted living and board and care hold the same license. A nursing home holds a different, medical license.
- Board and care or assisted living
6,924 of the 8,620 licensed homes are licensed for 6 or fewer residents.
- Memory care in California
California has no separate memory care license. 4,563 licensed homes have a dementia designation on the state record.
- What health needs a care home can take
A care home is not a nursing home: 24-hour skilled nursing, a feeding tube and some other conditions rule one out, except on hospice.
- If daily skilled nursing is needed: Skilled nursing facilities