Home Heath

The NOMNC is issued prior to (2 days/second to the last visit) when the agency anticipates the patient will be discharge . It should not be provided to the patient at the of an episode if the coverage is continuing.

There is an exception to the timing of the notice when care ends because the patient is no longer homebound. I recommend you provide the notice as soon as you learn that coverage has ended for an unexpected discharge that does not meet an exception at 260.2.1 in the manual .  

CMS Claims Processing Manual, chapter 30 Medicare Claims Processing Manual

260.2.1 - Exceptions

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• When beneficiaries end care on their own initiative

260.3.4 - Required Delivery Timeframes

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There is an accepted circumstance when the NOMNC may be delivered sooner than two days or the next to last visit before coverage ends. This exception is limited to cases where a beneficiary receiving home health services is found to no longer be homebound, and thus ineligible for covered home health care. In this circumstance, the NOMNC should be immediately delivered to the beneficiary upon discovery of the loss of homebound status. We expect that in the vast majority of cases, in all settings, the decision of a physician to end care will be based on medical necessity, and thus, foreseeable by the provider within the required time frames for notice delivery

Mary Carr, RN,MPH

V.P. for Regulatory Affairs

mcarr@allianceforcareinthehome.org / O: 202-567-7424