CMS Pub. 100-04, ch. 30, § 400.2

The MOON must be delivered to beneficiaries in Original Medicare (fee-for-service) and

Medicare Advantage enrollees who receive observation services as outpatients for more

than 24 hours. The hospital or CAH must provide the MOON no later than 36 hours after

observation services as an outpatient begin. This also includes beneficiaries in the

following circumstances:

• Beneficiaries who do not have Part B coverage (as noted on the MOON,

observation stays are covered under Medicare Part B).

• Beneficiaries who are subsequently admitted as an inpatient prior to the required

delivery of the MOON.

• Beneficiaries for whom Medicare is either the primary or secondary payer.

NOTES:

• For purposes of these instructions, the term “beneficiary” means either

beneficiary or representative, when a representative is acting for a beneficiary.

• Please see Chapter 13 of the Medicare Managed Care Manual for Medicare

Advantage instructions.

The statute expressly provides that the MOON be delivered to beneficiaries who receive

observation services as an outpatient for more than 24 hours. In other words, the statute

does not require hospitals to deliver the MOON to all beneficiaries receiving outpatient

services. The MOON is intended to inform beneficiaries who receive observation

services for more than 24 hours that they are outpatients receiving observation services

and not inpatients, and the reasons for such status, and must be delivered no later than 36

hours after observation services begin. However, hospitals and CAHs may deliver the

MOON to an individual receiving observation services as an outpatient before such

individual has received more than 24 hours of observation services. Allowing delivery of

the MOON before an individual has received 24 hours of observation services affords

hospitals and CAHs the flexibility to deliver the MOON consistent with any applicable

State law that requires notice to outpatients receiving observation services within 24

hours after observation services begin. The flexibility to deliver the MOON any time up

to, but no later than, 36 hours after observation services begin also allows hospitals and

CAHs to spread out the delivery of the notice and other hospital paperwork in an effort to

avoid overwhelming and confusing beneficiaries.

Hospitals Affected by these Instructions. These instructions apply to hospitals as well as

CAHs per section 1861(e) and section 1861(mm) of the Social Security Act.