The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act requiring written notification to Medicare patients of observation services became law on Aug. 6, 2015, and implementation is required by Aug. 6, 2016. In the proposed rule, the agency introduced the MOON, the Medicare Outpatient Observation Notice, which is the required form to be given to all patients who receive 24 or more hours of observation services. The comment period for the rule ended on June 17.

The notice provision will apply to both acute care hospitals AND critical access hospitals. The notice must be given to any patient who receives observation services as an outpatient for more than 24 hours. Hospitals must notify patients no later than 36 hours after service begins (sooner if the patient is released). You must provide written notification and an oral explanation of the written notification. The notification should be in "plain language" and in "appropriate languages." (Once an English-language version is approved, a Spanish-language one will follow.)

All beneficiaries are to be notified regardless of whether or not they are enrolled in Medicare Part B or a Medicare Advantage plan. Here are some strategies to consider to get prepared:

• Review your observation service line. 
• Determine when to conduct the notification process. Align the notification with existing processes (consent, disclosure, etc.).
• Determine who will perform the notification.
• Determine how the process will be performed.
• Determine if the process can be automated in the electronic health record.
• Consider supplemental materials in addition to the MOON that will be supplied by CMS (patient education pamphlets, etc.).
• Prepare for price transparency questions (impact on co-pays, cost of hospital-administered medications, supplemental coverages, etc.). SNF eligibility will require significant explanation.
• Prepare for patients leaving Against Medical Advice (AMA).
• Implement or formalize a patient follow-up program for patients discharged from the Emergency Department.

The act was created to better inform and educate patients and their caregivers. It does not fix hospital issues with documenting short-stay observation admissions or the three-day inpatient requirement for coverage for SNF services.