Medicare Advantage Issued Notices of Non-Coverage

Information for Home Health Agencies (HHAs),  Skilled Nursing Facilities (SNFs), and Comprehensive Outpatient Facilities (CORFs) for patients with Medicare Advantage (MA)

The following information relates to a new Medicare regulation pertaining to the rights of MA enrollees. The regulation effective January 1, 2004 addresses MA organizations' termination of service coverage. Termination of service coverage is an MA organizational decision to discontinue coverage of services being provided to an MA enrollee.

The Centers for Medicare & Medicaid Services (CMS) require that health care providers deliver the advance notice "Notice of Medicare Non-Coverage" (see links to "Further information" below). This is a standardized, largely generic notice to be given to each MA enrollee prior to the MA organization terminating coverage of a health care service. The notice contains only two patient-specific elements: the patient's name and the date services will end. These advance notices provide standardized information on a patient's appeal rights and instructions on how to initiate an appeal, if necessary.

After a Medicare beneficiary or his/her legal representative appeals the decision for discharge, the MA plan must provide a detailed explanation of why the decision was made for discharge. The Detailed Notice is a standard notice provided by CMS. MA plans may not deviate from the content of the form except where indicated (Form Instructions for Detailed Explanation of Non-Coverage). This notice must be provided no later than close of business of the day of the Quality Improvement Organization's (QIO's) notification of the appeal or close of business the day before discharge, whichever is later.

Further information for SNFs

Further information for HHAs

   Further information for CORFs 

Your Right Flyer