Medicare Advantage (M+C) Enrollee's Right

All Medicare Advantage (M+C) enrollees have the right to request a QIO fast-track review to appeal a decision to terminate coverage of services.

Termination occurs when the Medicare Advantage (M+C) organization decides to discontinue coverage of services currently being provided to an enrollee.

Settings Currently Affected by the New Appeal Rights

Home Health Agencies (HHAs)
Skilled Nursing Facilities (SNFs)
Comprehensive Outpatient Rehabilitation Facilities (CORFs)

Notice of Medicare Non-Coverage

Delivered by the HHA, SNF, or CORF, this notice contains only two patient-specific elements - the patient's name and the date services will end. These advance notices provided standardized information on a patient's appeal rights and instructions on how to initiate an appeal, if necessary.

Revised Notices Required August 1, 2004
Instructions about the NOMNC
Centers for Medicare & Medicaid Services (CMS) M+C appeal Web site

Administrative Memos

Clarification - Medicare+Choice Appeal and Grievance Procedure and "New Advance Notice"
QIO Review of Medicare + Choice Enrollee Appeals of Termination of Coverage in Multiple Settings

Adapted from CMS/Support QIO Policies and Procedures, Manual 10-10-2003