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Notice of Medicare Non-Coverage requirements: SNFs and home health providers

04/25/2018

Skilled nursing facilities and home health care providers must give the Notice of Medicare Non-Coverage (NOMNC) letter to Medicare Advantage patients in a timely fashion. This informs a Medicare beneficiary when services are ending and his/her rights on appealing the decision.

The Centers for Medicare & Medicaid Services says the NOMNC must be provided to and signed by the Medicare beneficiary in the following timeframes:

  • If care is provided daily — At least two calendar days before the covered services end.
  • If care isn’t provided daily — The second to the last day when the Medicare-covered services is provided.
  • If care is expected to take less than two calendar days — At the time of admission.

There are some exceptions to the NOMNC requirements. The notice doesn’t have to be provided to beneficiaries if they use up all their benefits, when they move to a higher level of care or when they don’t receive Medicare services in a covered setting. Please refer to this CMS document for details.

To help ensure timely delivery of the NOMNC, we encourage providers to provide the notice to our Medicare Advantage members as soon as they know when the services will end.

Please refer to the CMS website for details on the NOMNC form and how to properly fill it out. The information you will need specific to ConnectiCare is:

  • ConnectiCare is in Quality Improvement Organization (QIO) Area 1
  • The QIO name and contact numbers: Livanta, phone 1-866-815-5440, TTY: 1-866-868-2289
  • Medicare plan contact information: ConnectiCare, phone 1-800-224-2273

When our partner, CareCentrix manages post-acute care of Medicare members, providers must submit requests for reauthorization of services to CareCentrix at least 72 hours before the existing authorization of services expires.