NOMNC Appeal in Kentucky: How to Fight a Notice of Medicare Non-Coverage

What a NOMNC Means for Your Parent

A Notice of Medicare Non-Coverage (NOMNC) is the formal document a skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation facility must deliver when they plan to terminate Medicare-covered services. In plain terms: the facility is telling your parent that Medicare will stop paying — usually because they've determined the patient has "plateaued" or no longer needs daily skilled care.

Receiving a NOMNC does not mean your parent must leave immediately. It means a specific deadline is approaching, and you have a narrow window to challenge the decision.

The Appeal Deadline You Cannot Miss

In Kentucky, you must contact Acentra Health — the state's federally designated Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — by noon on the calendar day before the planned service termination.

Acentra Health Kentucky QIO line: 1-888-317-0751

The NOMNC must be delivered to the patient at least two days before the proposed termination date. That two-day window is your entire preparation time.

Here's the critical protection: once you file the appeal with Acentra Health before the deadline, Medicare coverage continues through the QIO review period. The facility cannot terminate services and cannot bill the patient for care provided while the review is pending.

How the Acentra Health Review Works

After you call the QIO line, Acentra's process unfolds in a compressed timeline:

1. Day of filing: Acentra acknowledges receipt and requests the patient's complete medical record from the facility
2. During the expedited review: Acentra's independent physician reviewers evaluate the clinical documentation against Medicare coverage criteria
3. Decision notification: Acentra issues a decision — either the facility's termination stands or coverage continues

During this period, your parent stays in the facility receiving the same services. No billing to the patient. No discharge. These are federal fast-appeal protections.

What Makes an Appeal Succeed

Acentra's physicians look for documented evidence that continued skilled services are still medically necessary. The strongest appeal arguments focus on:

• Active clinical instability: Documented vital sign fluctuations, uncontrolled pain, recent falls, or new symptoms that require skilled nursing assessment
• Functional decline risk: Objective therapy measurements showing the patient will deteriorate without continued skilled intervention (the Jimmo v. Sebelius settlement established that maintenance therapy qualifies — improvement is not the standard)
• Incomplete therapy goals: If the initial plan of care set specific milestones and those haven't been achieved, the termination is premature
• Unsafe home environment: If the patient cannot safely function at home because necessary supports (DME, home health, caregiver training) are not yet in place

What to Do When You Get the NOMNC

Immediately (within the first hour):

• Note the exact date and time the NOMNC was delivered
• Identify the proposed last day of coverage
• Call Acentra Health at 1-888-317-0751 and state clearly: "I am requesting an expedited review of a termination of Medicare services"

Within the next 24 hours:

• Request a copy of your parent's therapy progress notes from the past two weeks
• Ask the attending physician whether they agree with the termination — physicians sometimes disagree with the facility's utilization review committee but haven't been consulted
• Document any recent clinical events (falls, medication changes, new pain, behavioral changes) that support ongoing skilled needs

If the Appeal Fails

If Acentra upholds the facility's decision, you have further options:

• Further appeal: Follow the reconsideration instructions in Acentra's decision notice immediately; the next deadline depends on the type of Medicare appeal.
• Transition planning: The facility must provide a written discharge plan identifying the next care setting — this is not optional

However, once Acentra rules against continuing coverage, the patient may become financially responsible after the original proposed termination date.

The Jimmo Rule: Why "Plateaued" Is Not Grounds for Termination

Facilities frequently cite a patient's "plateau" — no measurable improvement — as justification for the NOMNC. Under the federal Jimmo v. Sebelius settlement (2013, clarification manual updated 2014), this reasoning is legally insufficient. Medicare covers skilled services to maintain the patient's current condition or prevent deterioration, regardless of whether the patient is actively improving. If a facility's NOMNC rests primarily on the plateau argument, that's your strongest appeal point.

The Hospital-to-Home Kentucky guide includes a NOMNC response worksheet with the exact timeline, documentation checklist, and talking points structured for the Acentra call — designed to be completed within the two-day window families actually have.

See more Kentucky guides →