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Hospital Discharge Rights and Rehab for Seniors
Many placements start with a hospital saying your parent can't go home. You have more rights at discharge than most people know, including the right to a fast appeal, and whether your parent was admitted or kept 'under observation' changes what Medicare pays for rehab.
Hospital discharge and rehab: the 2026 numbers
Medicare 3-day inpatient stay rule for skilled nursing coverage
Original Medicare generally covers skilled nursing facility care only after a medically necessary inpatient hospital stay of at least 3 days in a row. The count starts the day the person is formally admitted as an inpatient and does not include the day they leave. The person generally must enter the SNF within about 30 days of leaving the hospital and need daily skilled care. Medicare covers up to 100 days per benefit period.
Observation status does not count toward the 3-day rule
Days spent in the hospital under observation, or in the emergency room before a doctor's formal inpatient admission order, are outpatient days and do not count toward the 3-day inpatient stay. A parent can spend three nights in a hospital bed and still have no Medicare coverage for rehab afterward. Ask every day: is my parent an inpatient or under observation? Hospitals must give a Medicare Outpatient Observation Notice (MOON) if observation lasts more than 24 hours. Since February 14, 2025, a patient who was admitted as an inpatient and then switched to observation can ask for a fast appeal through the BFCC-QIO.
Medicare skilled nursing facility coinsurance, days 21 to 100
Days 1 to 20 in a Medicare-covered skilled nursing facility cost $0 after the Part A deductible. Days 21 to 100 cost $217 a day. After day 100 in a benefit period, Medicare pays nothing and the family pays all costs.
If you think the hospital, nursing home rehab, home health or hospice is ending Medicare-covered care too soon, you can ask an independent reviewer (the BFCC-QIO) for a fast decision. For a hospital, appeal no later than the day of discharge and you will not pay for the extra days while waiting, except usual coinsurance or deductibles. For rehab, home health or hospice, appeal by noon the day before services end.
When to use it: Use the moment you are told your parent is being discharged or rehab is ending and you believe it is too soon.
Deadlines are strict; call the BFCC-QIO number printed on the notice you were given right away.
Hospitals must give every Medicare inpatient, including Medicare Advantage members, this notice (form CMS-10065) explaining their discharge appeal rights. If you appeal, the hospital must give a Detailed Notice of Discharge explaining why it thinks your parent is ready to leave.
When to use it: Ask for and read this notice as soon as your parent is admitted, and again before discharge.
Livanta, CMS contractor (Medicare now lists it as Commence)
Free
The independent Medicare reviewer for fast discharge appeals and quality-of-care complaints in NY, NJ, PR, VI, PA, MD, DE, DC, VA, WV, OH, IN, IL, MI, MN, WI, IA, MO, KS, NE, CA, AZ, NV, HI, GU, MP and AS. Each region has its own toll-free number (for example Region 2: 1-866-815-5440; Region 3: 1-888-396-4646; Region 5: 1-888-524-9900; Region 7: 1-888-755-5580; Region 9: 1-877-588-1123).
When to use it: Call when you are appealing a discharge or want to report poor-quality care in one of these states.
The number depends on your parent's state; use the number on the discharge notice or the region list on the site.
Inpatient vs. Observation Status (Medicare Hospital Benefits)
Centers for Medicare & Medicaid Services (CMS)
Free
Medicare's fact sheet (December 2025) explains that your parent can stay overnight in the hospital and still be an outpatient under observation. Observation days do not count toward the 3 inpatient days needed for Medicare to cover nursing home rehab.
When to use it: Ask on day one whether your parent is admitted as an inpatient or under observation, because it decides rehab coverage.
Being under observation can leave your family paying the full cost of nursing home rehab.
Observation Status Help (Center for Medicare Advocacy)
Center for Medicare Advocacy
Free
A nonprofit law organization's guide to observation status: why it matters, the MOON notice hospitals must give within 36 hours after 24 hours of observation, and the new appeal right won in the Alexander v. Becerra class action.
When to use it: Use if your parent was kept under observation and now faces rehab or hospital bills.
Skilled Nursing and the Improvement Standard (Center for Medicare Advocacy)
Center for Medicare Advocacy
Free
Explains that Medicare covers skilled care to maintain your parent's condition or slow decline, not only to improve it (the Jimmo settlement), and how to fight rehab cut-offs.
When to use it: Use when a rehab facility says your parent is 'not making progress' and coverage will end.