Medicare Advantage

MEDICARE ADVANTAGE (MA) ENROLLEE’S RIGHTS

All Medicare Advantage (MA) 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 (MA) 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.