Case Review Connections

Medical Director's Corner

Written by Jessica Whitley, MD, MBA

Immediate Advocacy Discharge Assistance

The Immediate Advocacy Discharge Assistance (IADA) process is a voluntary, patient-centered intervention. It is available only to traditional Medicare beneficiaries facing discharge from an acute-care hospital. It does not apply to Medicare Advantage plan decisions, skilled nursing facility (SNF) coverage disputes, or hospital outpatients under observation status.

To be eligible, beneficiaries must have inpatient status and have received an Important Message from Medicare (IM) notice.

• IADA does not change the formal appeal process. Instead, it provides rapid communication support.

For peace of mind, beneficiaries are told upfront that participation in IADA will not affect their appeal rights or outcomes. A separate case ID is created for the IADA intervention, while the appeal continues under the original case number.

The IADA team focuses on facilitating dialogue between the beneficiary and the hospital when there are concerns about discharge readiness, discharge location, or communication gaps. Acentra Health does not request medical records for IADA, since it is a verbal, advocacy-based process. However, records will still be required for the formal appeal.

If patients or families have concerns, such as uncertainty about an accepting SNF or confusion about the recommended discharge plan, Acentra Health can help coordinate discussions with the case manager or care team. If the hospital cannot reach the IADA representative who left a message, this has no impact on the appeal. Beneficiaries may continue with Immediate Advocacy or the standard appeal.

• Acentra Health will make multiple attempts to reach the appropriate hospital contact, including designated coverage staff when a case manager is on vacation.

Finally, if a beneficiary decides to withdraw their appeal after the IADA intervention, the IADA team will inform the hospital’s case manager directly. Hospitals do not need to submit additional documentation.

While IADA does not produce written case summaries, the usual Medicare discharge appeal notifications remain unchanged. For SNF residents or MA enrollees, traditional Immediate Advocacy, not IADA, remains the appropriate route for addressing concerns about care or discharge decisions.

For more information on this topic, look at our YouTube video: Immediate Advocacy Discharge Assistance Process.

Appeals Update

The Office of Management and Budget (OMB) control number for the IM and the Detailed Notice of Discharge (DND) expired on December 31, 2025. Providers may continue using the current notices after expiration until the Centers for Medicare & Medicaid Services (CMS) issues further guidance. Once reauthorized, CMS will notify the industry, and providers will have 60 days from the announcement to begin using the updated IM/DND. More information is available on the CMS website.

Reminder: Acentra Health does not need to wait for the DND to be provided to us. Under the regulations, the hospital is required to issue the DND to the patient at the time the patient requests an appeal. Our review is not contingent upon receipt of the DND, and we do not delay completing the review while waiting for it. Additionally, the DND has no impact on financial liability and should not be a barrier to completing the hospital discharge appeal.

Acentra Health Resources - Beneficiary Complaint Podcast

Acentra Health has a new podcast episode focusing on the beneficiary complaint process. The two hosts were our Operations Manager, Carla Boguslawski, MBA, MEd, BS, and Melinda Burk, LPN, Clinical Review Nurse. This has useful information for Medicare beneficiaries that may have concerns about the health care they received.

CMS Quality Conference - March 16-18, 2026

The CMS Quality Conference brings together leaders, providers, researchers, advocates, and partners who are all committed to improving healthcare quality and outcomes. This year’s theme, Make America Healthy Again: Innovating Together for Better Health, focuses on bold ideas and teamwork to create real change.

Virtual attendance is available. For more information or to register, visit CMS Quality Conference 2026.

Rural Health Updates

CMS announced $50 billion in funding for the Rural Health Transformation Program. This is a nationwide initiative established under Public Law 119-21 to strengthen and modernize rural health care in all 50 states.

• To assist with this initiative, CMS has announced the establishment of the Office of Rural Health Transformation (ORHT) within the Center for Medicaid and CHIP Services (CMCS).

Beginning in 2026, each state will receive first-year awards averaging about $200 million, with amounts ranging from roughly $147 million to $281 million. The investment aims to expand access to care for the more than 60 million Americans living in rural areas by:

• Improving primary, preventive, maternal, behavioral, and emergency services
• Strengthening the rural health workforce
• Modernizing facilities and technology
• Supporting innovative, community-based care models

Federal leaders emphasized that the program is designed to give states and local providers greater control to deliver high-quality, affordable care closer to home.

Additional information on the Rural Health Transformation Program is available at http://www.cms.gov/RHTProgram. CMS also put out a press release with the award amounts.

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