A Notice of Medicare Non-Coverage is required when a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility (CORF), or hospice agency decides to end all of your Medicare-covered services, and the provider must hand it to you at least two calendar days before those services stop.1Centers for Medicare & Medicaid Services. FFS and MA NOMNC/DENC2eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Service Terminations Outside that narrow set of providers and that specific type of decision, the notice does not apply, and its absence is not a mistake.
The Four Provider Settings That Must Issue a NOMNC
Federal regulations tie the NOMNC to four provider types:
- Skilled nursing facilities
- Home health agencies
- Comprehensive outpatient rehabilitation facilities
- Hospice agencies
If your Medicare-covered care is coming from one of these providers and the provider is ending that care, you should receive the NOMNC.1Centers for Medicare & Medicaid Services. FFS and MA NOMNC/DENC Care delivered anywhere else falls outside the requirement. Hospitals, physician offices, emergency rooms, outpatient clinics, and standalone therapy practices do not use the NOMNC. When a hospital discharges you, the equivalent notice is the Important Message from Medicare (IM), given to every Medicare inpatient, with its own separate appeal process.3Centers for Medicare & Medicaid Services. FFS and MA IM
The Timing Rule
The provider must deliver the NOMNC at least two calendar days before your covered services are set to end.2eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Service Terminations If your stay or treatment is expected to last fewer than two days, you should receive the notice at the time of admission. The purpose is to give you enough runway to request an expedited appeal before coverage stops.4Centers for Medicare & Medicaid Services. Form Instructions for the Notice of Medicare Non-Coverage
When a NOMNC Is Not Required
Knowing the situations that fall outside the rule is often the fastest way to see whether you should have received one.
Your Services Are Being Reduced, Not Ended
The regulation covers terminations, and a termination does not include a reduction in services.2eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Service Terminations CMS form instructions are explicit that providers should not use the NOMNC when a reduction or termination does not end the skilled Medicare stay.5Centers for Medicare & Medicaid Services. Form Instructions for the Notice of Medicare Non-Coverage – Section: Special Circumstances A home health agency that cuts your physical therapy from three visits a week to one, while continuing skilled nursing visits, is still providing Medicare-covered care and owes no NOMNC.
A significant cut can feel like a termination, and it is reasonable to want to push back. But the expedited NOMNC appeal is not the vehicle. Disputes over reductions go through a standard Medicare appeal or a complaint to your state’s Quality Improvement Organization.
Medicare Wasn’t Paying for the Care to Begin With
The notice only triggers when Medicare-covered services are ending. If Medicare wasn’t paying, there is nothing to announce.
Custodial care is the common example. Help with bathing, dressing, eating, and similar daily tasks does not qualify as skilled care, and Medicare generally does not pay for it.6Medicare. Nursing Home Care Most nursing home care falls into this category.7Medicare.gov. Long-Term Care The same logic applies once you have used up your benefit: Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility, and after that the NOMNC has nothing to operate on. When a provider decides your condition no longer requires skilled care, the correct form is often an Advance Beneficiary Notice of Non-coverage (ABN), not a NOMNC.
You Choose to End Services
The NOMNC exists to let you challenge a provider’s decision. When you are the one deciding to stop, there is no provider action to appeal, and CMS guidance directs providers not to issue the notice when beneficiaries end care on their own initiative.8Centers for Medicare & Medicaid Services. Transmittal R2711CP – Section: 260.2.1 Exceptions The same principle covers hospice: revoking the hospice benefit to return to standard Medicare, or transferring to a different hospice agency, does not require a NOMNC because the hospice is not cutting off your care.
The Care Is in a Setting Outside the Four Provider Types
Even if covered services are ending, care delivered outside a skilled nursing facility, home health agency, CORF, or hospice will not come with a NOMNC.2eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Service Terminations Hospital inpatients get the Important Message from Medicare instead.3Centers for Medicare & Medicaid Services. FFS and MA IM Physicians who stop a course of treatment may trigger other Medicare appeal rights, but not this one.
Medicare Advantage: Same Trigger, Different Appeal Path
If you are enrolled in a Medicare Advantage plan, the NOMNC still applies when your plan’s contracted skilled nursing facility, home health agency, CORF, or hospice ends your services.1Centers for Medicare & Medicaid Services. FFS and MA NOMNC/DENC The form itself is the same, but the appeal after you receive it follows the Medicare Advantage fast-track path rather than the Original Medicare expedited determination rules. Every exception above still applies: reductions, care Medicare never covered, voluntary decisions, and care in other settings all remain outside the requirement.
What to Do When You Receive One
If you get a NOMNC and disagree with the provider’s decision, you can request an expedited determination from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your state. The deadline is short: you must contact the QIO by noon of the calendar day after you receive the notice, by phone or in writing.
Filing on time keeps two protections in place. Your coverage continues through the review period, and the provider cannot bill you for the disputed services until the QIO decides. The QIO must issue a determination within 72 hours. Missing the deadline does not forfeit your appeal, but you lose the 72-hour window and the financial liability shield.9eCFR. 42 CFR 405.1202 – Expedited Determination Procedures If the QIO finds you never received valid notice, your coverage continues for at least two more days after you receive a proper one.
Telling the NOMNC Apart From the ABN and the IM
Three Medicare notices get confused for one another. The quickest way to identify which one belongs in your situation is to ask which type of provider is making the decision and what exactly they are deciding.
- NOMNC: issued by a skilled nursing facility, home health agency, CORF, or hospice when all Medicare-covered services from that provider are ending. Opens an expedited QIO appeal.
- ABN: issued before a specific item or service when the provider believes Medicare probably will not pay. It shifts financial liability to you if you choose to receive the service anyway, and it applies across many provider types.
- Important Message from Medicare: given to every Medicare hospital inpatient, explaining discharge appeal rights through a separate process.3Centers for Medicare & Medicaid Services. FFS and MA IM
A hospital ending your inpatient stay triggers the IM. A home health agency ending all your skilled visits triggers the NOMNC. A doctor’s office telling you Medicare will not cover a particular test triggers the ABN. That is the map from setting to notice to appeal path.