Waiting on CMS to Finalize MOON

Access Departments may expect to provide Medicare patients with the new Medicare Outpatient Observation Notice (MOON). As of mid-day today, August 2, CMS has not finalized the MOON.  A draft MOON, different from an earlier draft notice form, along with instructions and background information, may be found on the CMS webpage here.  NAHAM will provide additional information as we are able to obtain it from CMS.

The Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) of 2015 requires hospitals and Critical Access Hospitals (CAH) to provide written and oral notification to individuals receiving observation services as outpatients for more than 24 hours. The NOTICE Act required the Secretary of Health and Human Services (HHS) to develop a notice form that explains why the patient is receiving observation services, the implications of receiving outpatient observation services, such as cost sharing, and post-hospitalization eligibility for Medicare coverage of skilled nursing facility (SNF) services. The NOTICE Act also created an effective date of August 6, 2016.  In an April 27, 2016 proposed rule, CMS provided an opportunity for public comments on its proposed hospital and CAH notification procedures for outpatients receiving observational services.

Hospitals and CAHs will be required to furnish a new CMS-developed standardized notice, the Medicare Outpatient Observation Notice (MOON), to a Medicare beneficiary or enrollee who has been receiving observation services as an outpatient for more than 24 hours. The notice must be provided no later than 36 hours after observation services are initiated. 

In its guidance, CMS notes that although hospitals must provide a hard copy of the MOON to CMS beneficiaries and enrollees, hospitals may retain a copy of the signed MOON electronically.  In cases where the beneficiary has a representative who is not physically present, hospitals are permitted to give the MOON by telephone as long as a hard copy is delivered to the representative.

CMS indicates that “When delivering the MOON, hospitals and CAHs are required to explain the notice and its content, document that an oral explanation was provided and answer all beneficiary questions to the best of their ability.” Because oral explanation of the MOON must be provided, as a practical matter that explanation will be provided in conjunction with the delivery of the hard copy notice.  CMS indicates that a Spanish language version of the MOON will be made available.  Where an individual receiving the notice is unable to read its written contents and/or comprehend the required oral explanation, CMS expects hospitals and CAHs to “employ their usual procedures to ensure notice comprehension”.  CMS will provide guidance for oral notification in its forthcoming Medical manual provisions.

A signature must be obtained from the individual, or an individual qualified to act on their behalf, to acknowledge receipt and understanding of the notice (or in cases of refusal of signature by such individual, signature by the staff member of the hospital or CAH providing the notice).

It is very likely Access Departments will be asked to provide a copy of the MOON notice at the point of entry, much as most Access Departments do with the IMM (Important Message from Medicare). This may be the most practical way to meet the requirement that the notice be given no later than 36 hours after observational services are initiated.  The requirement that a verbal explanation be given as well, Access Departments should anticipate having to provide the oral explanation of the MOON as well.  If the patient has any specific questions about the notice, the form of the notice or his or her observational status, Access Departments can refer the patient to Case Management.

Because the MOON is a CMS standardized notice, it was required to go through the Paperwork Reduction Act process, thus affording the public an opportunity to comment on the proposed MOON. This has caused a delay in finalizing the content and format of the notice by the August 6 statutory effective date.