How to Appeal an Unsafe Hospital Discharge in Maryland

If a Maryland hospital is discharging your parent and you believe the discharge is unsafe, you can file an expedited appeal through Livanta LLC (currently contracted to Commence Health) and temporarily halt the discharge while an independent reviewer evaluates the case. The deadline is midnight on the day of the planned discharge. The hospital cannot discharge your parent while the appeal is pending. Here's exactly how to do it.

The Timeline That Matters

The hospital must give your parent a written discharge notice called the Important Message from Medicare (IM). This notice starts the clock. From the moment your parent receives the IM, you have until midnight on the planned discharge date to contact Commence Health and request a quality of care review.

If you miss this deadline, you can still file a standard appeal, but the hospital is no longer required to keep your parent during the review. The expedited appeal — filed before midnight — is the one with teeth.

Step-by-Step Appeal Process

Step 1: Document the safety concern. Before you call, write down specifically why you believe the discharge is unsafe. "My parent can't walk to the bathroom unassisted and the discharge plan sends them home alone" is stronger than "I don't think they're ready." Note the specific functional limitations, any medical equipment still needed, whether home care services have been arranged, and whether the hospital has complied with Maryland's Lay Caregiver Act (COMAR 10.07.01.35) by training a designated caregiver.

Step 2: Call Commence Health. This is Maryland's Beneficiary and Family Centered Care Quality Improvement Organization, contracted through Livanta LLC. State that you want to file an expedited quality of care review regarding a hospital discharge. Give them the patient's name, Medicare number, hospital name, and your relationship to the patient.

Step 3: Record your case number. You'll receive a case number during the call. Write it down. This is your reference for everything that follows.

Step 4: The review begins. An independent physician reviewer — not affiliated with the hospital — will evaluate whether the discharge is medically appropriate. The hospital must provide the reviewer with the patient's medical records. During this review period, the hospital cannot discharge your parent.

Step 5: The decision. For expedited reviews, the decision typically comes within 24–72 hours. If the reviewer agrees the discharge is premature, the hospital must continue care. If the reviewer upholds the discharge, you can appeal further to the Departmental Appeals Board, though the hospital can proceed with discharge at that point.

What Counts as an Unsafe Discharge

Not every early discharge qualifies, but these situations commonly warrant an appeal:

• Patient cannot perform basic activities of daily living (toileting, transferring, feeding) and no home care has been arranged
• Discharge plan assumes a family caregiver is available, but no caregiver training has been provided under Maryland's Lay Caregiver Act
• Patient requires wound care, IV medications, or monitoring that hasn't been transitioned to an outpatient provider
• Patient has cognitive impairment (dementia, delirium) and the discharge plan sends them to an unsupervised setting
• The hospital is discharging to a skilled nursing facility that doesn't have the appropriate license or specialty for the patient's condition

The Observation Status Trap

Before filing an appeal, verify your parent's admission status. If your parent is under "observation status" rather than admitted as an inpatient, the appeal process still works — but the financial implications are different. Observation patients don't accumulate the three qualifying inpatient days required for Medicare to cover skilled nursing facility care after discharge.

The hospital is required to issue a Medicare Outpatient Observation Notice (MOON) within 36 hours of placing a patient in observation status. If your parent was in observation and you weren't given a MOON, document that as part of your appeal.

What the Hospital Cannot Do

Maryland law and federal regulations set clear boundaries on hospital behavior during a discharge:

• The hospital cannot discharge your parent while an expedited appeal is pending
• The hospital cannot require you to choose a facility from their referral list only — you have the right to select any licensed facility
• The hospital must comply with COMAR 10.07.01.35 caregiver training requirements before discharge
• The hospital must provide a discharge plan that addresses medication management, follow-up appointments, and home safety

Building Your Case

The Maryland Discharge Navigation System includes a Livanta Appeal Worksheet — a fillable one-page form designed specifically for this situation. It walks you through documenting your parent's functional limitations, the gaps in the discharge plan, and the specific Maryland regulations the hospital may not be following. Having this information organized before you call Commence Health makes your appeal significantly stronger.

The guide also covers what happens after the appeal — whether the discharge is upheld, reversed, or leads to a different post-acute care arrangement — so you're prepared for every outcome.

Frequently Asked Questions

How long does a Maryland hospital discharge appeal take?

Expedited reviews through Commence Health typically result in a decision within 24–72 hours. Standard reviews (filed after the discharge deadline) can take longer. During an expedited review, the hospital must continue to provide care.

Can I appeal a discharge from a skilled nursing facility in Maryland?

Yes. The same Livanta/Commence Health appeal process applies to discharges from skilled nursing facilities. Additionally, nursing home residents have separate federal protections under 42 CFR § 483.15 that require 30-day advance written notice and specific grounds for discharge.

What if I miss the midnight deadline?

You can still file a standard quality of care review, but the hospital is no longer required to keep your parent during the review process. If you're close to the deadline, call immediately — even a call placed at 11:30 PM counts if it's before midnight.

Does filing an appeal affect my parent's care at the hospital?

Legally, no. The hospital is prohibited from retaliating against a patient for filing a discharge appeal. Practically, document everything and maintain a cooperative tone with the care team — you're exercising a legal right, not initiating a conflict.

Is there a cost to filing a discharge appeal in Maryland?

No. The appeal through Commence Health/Livanta is free. It's a Medicare beneficiary right. The review is conducted by an independent physician at no cost to the patient or family.

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