Current through Register Vol. 51, No. 19, September 20, 2024
A. A hospital shall provide both an oral and
written notice to a patient of:
(1) The
patient's outpatient on observation status;
(2) The billing implications of the
outpatient on observation status; and
(3) The impact of the outpatient on
observation status on the patient's eligibility for Medicare rehabilitation
services if:
(a) The patient received on-site
services from the hospital for more than 23 consecutive hours;
(b) The on-site services received by the
patient include a hospital bed and meals that have been provided in an area of
the hospital other than the Emergency Department; and
(c) The patient is classified as an
outpatient at the hospital for observation rather than as an admitted
inpatient.
B.
The written notice shall include:
(1) That the
patient is considered to be on observation as an outpatient and is not admitted
as an inpatient;
(2) The reason or
rationale that the patient has not been admitted for inpatient
services;
(3) That the patient, if
needed upon discharge, may not qualify for Medicare Part A reimbursement for
rehabilitation services, including such services provided under Medicare Part A
in a skilled nursing facility;
(4)
That there may be billing implications based on their outpatient status that
may increase the patient's out-of-pocket costs for their stay;
(5) The name and title of the staff who
provided the oral notice stating the date and time of the oral notice;
and
(6) The signature of the
patient to verify an understanding and receipt of the written notice.
C. Once the patient has received
onsite services for more than 23 hours, the hospital shall provide written and
oral notice to the patient that the physician has ordered services be provided
as outpatient on observation status.
D. The oral and written notice shall be
provided in a manner that is understood by the patient.
E. If the patient lacks capacity to
understand the medical or financial implications of his or her outpatient on
observation status, the oral and written notice shall be provided to a person
authorized to make medical or financial decisions for the patient, including:
(1) A guardian of the person under Estates
and Trusts Article, §13-705, Annotated
Code of Maryland;
(2) A guardian of
the property under Estates and Trusts Article, §13-201, Annotated
Code of Maryland;
(3) An agent
appointed under an advance directive that meets the requirements of
Health-General Article, §5-602, Annotated Code of Maryland;
(4) A surrogate decision maker with authority
under Health-General Article, §5-605, Annotated Code of
Maryland;
(5) An agent appointed
under a power of attorney that meets the requirements of Estates and Trusts
Article, Title 17, Annotated Code of Maryland;
(6) A representative payee or other similar
fiduciary; or
(7) Any other person,
if that person was designated by the patient who was competent at the time of
designation, and the patient or representative has provided the hospital with
documentation of the designation.
F. For Medicare patients only, a hospital has
the option to provide only the notice required by Medicare under
42 CFR § 489.20(y). Hospitals that
elect to use that option shall be considered compliant with this regulation if
the notice is provided to patients that receive on-site services for more than
23 hours.
