During the past year, the Center for Medicare Advocacy has received an alarming increase in complaints from Medicare Advantage enrollees who, despite requiring skilled nursing facility (“SNF”) care, receive Notices of Medicare Non-Coverage (“NOMNCs”) stating that their Medicare Advantage plan has decided to terminate coverage of their SNF care. Although these patients frequently win expedited appeals of the Medicare coverage denials, their Medicare Advantage plans often respond by issuing a new NOMNC within several days after losing the first appeal, essentially starting the coverage denial process over again and forcing enrollees and their families to respond to a barrage of routine coverage denials. These denials conflict with the opinions of the beneficiaries’ providers, the skilled nursing and/or skilled therapy required, and the total condition of the patient. Discharge plans are rarely in place.
Although there is no appeal process to prevent MA Plans from issuing these routine NOMNCs, we want to assist enrollees and their families in challenging the practice. One way for Medicare Advantage enrollees to push back against this spike in improper and harassing denials of Medicare coverage is to file a formal complaint with the plan, known as a Grievance. The Center has drafted a Grievance form, that can be filed with a plan that issues inaccurate and repetitive NOMNCs. After receiving a properly completed Grievance, an MA Plan must respond in writing and complete certain reporting requirements to CMS pursuant to federal regulations.
Additionally, we encourage enrollees who file grievances with their plans to send copies of the Grievances to their state and federal representatives and to the Center for Medicare Advocacy.
- Download the form and instructions at https://medicareadvocacy.org/wp-content/uploads/2022/08/MA-Grievance-Form.docx
August 25, 2022 – J. Lalor