NOMNC Appeal Washington State: How to Fight a Notice of Medicare Non-Coverage

What the NOMNC Means

A Notice of Medicare Non-Coverage (NOMNC) is a formal written notice that your parent's Medicare-covered services are being terminated. This applies to skilled nursing facility (SNF) stays, home health services, comprehensive outpatient rehabilitation, and hospice care.

The NOMNC is distinct from the "Important Message from Medicare" (IM), which applies specifically to hospital inpatient discharge appeals. The NOMNC covers post-acute and community-based service terminations — and the appeal process, timelines, and decision-makers are different.

When a provider determines that your parent no longer meets Medicare's coverage criteria for a service, they must deliver the NOMNC at least two days before the proposed termination date. This notice must include:

• The date services will end
• A clear statement of the patient's right to an expedited review
• Contact information for the Quality Improvement Organization (QIO) responsible for the review
• Instructions for requesting the review

In Washington State, the designated Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is Acentra Health. All NOMNC appeals for Washington residents go through Acentra.

The Critical Timeline

The timing of your appeal determines whether your parent continues receiving services during the review:

If you appeal by noon on the day before the proposed termination date: Medicare-covered services continue without interruption until Acentra issues its decision. The provider cannot terminate services or bill your parent during the review period. This is the most important deadline — missing it means your parent's coverage ends as scheduled while the appeal is processed.

If you appeal after the noon deadline but within 60 days of the effective date: You can still request an untimely review, but services will be terminated on the proposed date and the coverage protections for a timely appeal do not apply. If your parent is still receiving services, the QIO must make a determination within 7 days; if services have ended, within 30 days.

If you do not appeal within 60 days of the effective date: The QIO's untimely-review window has closed. Contact Medicare promptly about the standard claims appeal process.

How to File the Appeal

Contact Acentra Health directly:

• Phone: 1-888-319-8452 (TTY: 1-855-843-4776)
• Hours: Helpline staff hours vary; messages can be left 24 hours a day, 7 days a week

When you call, state clearly that you are requesting an expedited review of a NOMNC. Provide:

• Your parent's full name and Medicare number
• The name and address of the provider that issued the NOMNC
• The date on the NOMNC and the proposed termination date
• Your relationship to the patient and your contact information
• A brief statement of why you believe services should continue

Acentra will obtain the medical records from the provider and make its determination. For expedited reviews, the decision must be issued within 72 hours of receiving the request. This is fast — often faster than families expect.

What Acentra Reviews

Acentra's clinical reviewers evaluate whether your parent still meets Medicare's coverage criteria for the specific service:

For SNF stays: Does the patient require daily skilled nursing care or skilled rehabilitation services (physical therapy, occupational therapy, speech therapy) that can only be provided in an inpatient setting? Medicare covers SNF stays following a qualifying three-midnight hospital stay, but only as long as the patient demonstrates functional improvement or requires skilled maintenance care.

For home health: Is the patient homebound? Do they require intermittent skilled nursing, physical therapy, speech therapy, or occupational therapy? Medicare home health coverage does not require a prior hospital stay, but the patient must need skilled services — personal care alone does not qualify.

For hospice: Has the patient's prognosis changed? Did the patient or family revoke the hospice election? Hospice coverage continues as long as the certifying physician and hospice medical director agree that the patient's life expectancy is six months or less if the disease runs its normal course.

If the Appeal Fails

If Acentra upholds the service termination, you have further appeal options through the standard Medicare appeals process:

Level 2 — Qualified Independent Contractor (QIC) Reconsideration: File within 180 days of the initial determination. The QIC conducts an independent review of the clinical evidence.

Level 3 — Administrative Law Judge (ALJ) Hearing: If the amount in controversy meets the threshold ($200 in 2026), request a hearing using Form OMHA-100 within 60 days of the QIC decision. ALJ hearings allow you to present additional evidence and testimony.

Level 4 — Medicare Appeals Council Review: Within 60 days of the ALJ decision.

Level 5 — Federal District Court: Within 60 days of the Appeals Council decision, if the amount in controversy meets the judicial review threshold ($1,960 in 2026).

Most NOMNC disputes are resolved at Level 1 (Acentra) or Level 2 (QIC). The higher levels are available but rarely necessary for individual service termination cases.

Common Situations Where an Appeal Is Worth Filing

SNF therapy discharge when your parent is still improving. Facilities sometimes issue the NOMNC because the therapy team has reached its internal goals, even though the patient continues to show measurable functional progress. If your parent's physical or occupational therapist documents ongoing improvement, the appeal has a reasonable chance of success.

Home health termination after a fixed number of visits. Medicare does not impose a visit limit on home health — coverage continues as long as the clinical criteria are met. If a home health agency terminates services after a predetermined number of visits (say, six weeks regardless of clinical status), challenge the termination.

SNF discharge to a lower level of care that the family believes is premature. If your parent cannot safely perform basic ADLs without skilled assistance and the discharge plan does not include adequate community-based services, the clinical basis for termination is weaker.

For families managing Medicare appeals alongside a broader hospital-to-home transition, the Hospital-to-Home Washington guide includes discharge appeal script templates for both hospital and SNF settings, plus the full BFCC-QIO contact details and form references.

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