THE SHORT ANSWER

If a hospital says your parent is ready to leave and you don't believe it's safe, you have rights. Medicare patients who are admitted as inpatients receive a notice called the Important Message from Medicare, which explains how to request a fast, free appeal to an independent reviewer. In New York, that reviewer is Commence Health (formerly Livanta), 1-866-815-5440. Call before your parent leaves the hospital, and ideally no later than the planned discharge day.

The call usually comes fast: "Your mom is being discharged tomorrow." Maybe she can't manage stairs yet. Maybe she lives alone. Maybe nobody has talked about what happens next. Take a breath. You have more time and more rights than it feels like right now.

Hour 0–12: find out three things

  1. Is your parent an inpatient or under observation? Ask directly: "Is she admitted as an inpatient, or here on observation status?" It changes almost everything — including whether Medicare will cover rehab afterward. Why it matters.
  2. What is the discharge plan, in writing? Home, home with services, subacute rehab, or a facility — and who is arranging it.
  3. Has your parent received the Important Message from Medicare? Inpatients should receive this notice shortly after admission and again before discharge. It explains the appeal right.

Hour 12–24: say what's unsafe, in writing

Talk to the discharge planner or case manager. Be specific and calm:

"I don't believe this plan is safe. She fell twice this month, she lives alone, and she can't get to the bathroom without help. I'd like to discuss what services or setting would make discharge safe."

Then send the same thing in an email or note to the planner and the hospital's patient advocate. Written concerns get documented.

If you still disagree: the fast appeal

Medicare inpatients — in Original Medicare or a Medicare Advantage plan — can ask an independent reviewer to look at the discharge decision.

  • Who to call: New York's Medicare Quality Improvement Organization: Commence Health (formerly Livanta), 1-866-815-5440. The number is also on the Important Message notice.
  • When: before your parent leaves the hospital, and no later than the planned discharge day.
  • What happens: the reviewer looks at the medical records, usually decides within a day or two, and calls you.
  • The cost: there's no charge to appeal. For Original Medicare inpatients who appeal on time, the hospital generally can't bill for the days while the decision is pending.

An appeal doesn't always change the outcome, but it very often buys time to arrange a better plan.

Hour 24–72: line up where your parent goes next

If rehab is recommended, Medicare can cover skilled nursing after at least 3 inpatient days (not counting the discharge day): days 1–20 in full, and $217 per day for days 21–100. You have the right to choose among facilities that have a bed. The hospital should give you a list. Choosing a rehab facility in 24 hours.

If your parent can go home with help, ask who is ordering home health services, when the first visit will be, and what equipment is needed before arrival.

If your parent can't go home and rehab isn't appropriate, assisted living, an adult home, or respite care may be options — sometimes within days. This is where a local placement advisor can help most.

What to bring to every conversation

  • A list of medications and doctors
  • Health care proxy and power of attorney documents
  • Insurance cards (Medicare, Medigap or Advantage plan, Medicaid if any)
  • Your notes: who said what, and when

Printable hospital discharge checklist.

Questions families ask

Will we be charged for the extra days while the appeal is reviewed?

For Original Medicare inpatients who appeal on time, the hospital generally can't bill for the days while the reviewer decides. Ask the hospital to confirm in writing.

Does the appeal work with a Medicare Advantage plan?

Yes. Inpatients in Medicare Advantage plans have the same right to a fast appeal of a hospital discharge.

What if my parent is under observation, not admitted?

Observation patients are outpatients. The inpatient discharge appeal doesn't apply the same way, and observation days don't count toward Medicare's skilled nursing requirement. Ask about status early.

Can the hospital discharge someone to an unsafe place?

Hospitals must plan a safe discharge. If you believe the plan isn't safe, say so in writing to the discharge planner and the patient advocate, and use the appeal if it applies.

Keep exploring

A person to help you make sense of it.

Cardinal Care Advisors helps families explore senior living options in Western New York. Ask about fit, availability, next steps, and partner relationships.

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Cardinal Care Advisors placement guidance is free to families. Some senior living communities pay Cardinal a referral fee when a family moves in. Homeward is a separate paid service. How Cardinal is paid.

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