Updated Medicare Beneficiary Non-Coverage Notice Forms Effective January 1, 2025

• By: Maureen Carland
• On: 12/30/2024 09:40:51
• In: Quality/Regulatory

The Centers for Medicare and Medicaid Services (CMS) have updated certain Medicare beneficiary non-coverage notice forms, applicable to both Medicare Fee-for-Service and Medicare Advantage beneficiaries. These updates will take effect on January 1, 2025.

Fee-for-Service Medicare Providers:
Skilled Nursing Facilities (SNFs) must issue a Notice of Medicare Non-Coverage (NOMNC) to beneficiaries when Medicare-covered services are ending. The NOMNC informs beneficiaries of their right to request an expedited determination from their Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

A Detailed Explanation of Non-Coverage (DENC) is provided only if the beneficiary requests an expedited determination. The DENC outlines the specific reasons why covered services are ending.

Medicare Advantage Plans:
The updated NOMNC reflects new regulations granting enrollees additional fast-track appeal rights. These rights apply when enrollees make an untimely request to appeal to the BFCC-QIO or wish to appeal after services have ended on or before the planned termination date (refer to CMS-4205-F, p. 30827).

Additionally, DENC instructions now require Medicare Advantage (MA) plans to include a new element. If the enrollee has previously received a favorable BFCC-QIO appeal decision during the current care episode, MA plans must explain specific changes in the enrollee's condition that justify the decision to terminate services.

Additional Resources:
For the updated forms and instructions, visit the “Downloads” section of the CMS Fee-for-Service & Medicare Advantage NOMNC/DENC webpage. Questions about the NOMNC and DENC can be submitted via the provided CMS contact options.
 
Staff contact: mcarland@mehca.org