CMS Pub. 100-04, ch. 30, § 260.2.1

The following service terminations, reductions, or changes in care are not eligible for an

expedited review. Providers should not deliver a NOMNC in these instances.

When beneficiaries never received Medicare covered care in one of the covered settings

(e.g., an admission to a SNF will not be covered due to the lack of a qualifying hospital

stay or a face-to-face visit was not conducted for the initial episode of home health care).

When services are being reduced (e.g., an HHA providing physical therapy and

occupational therapy discontinues the occupational therapy).

When beneficiaries are moving to a higher level of care (e.g., home health care ends

because a beneficiary is admitted to a SNF).

When beneficiaries exhaust their benefits (e.g., a beneficiary reaches 100 days of

coverage in a SNF, thus exhausting their Medicare Part A SNF benefit).

When beneficiaries end care on their own initiative (e.g., a beneficiary decides to revoke

the hospice benefit and return to standard Medicare coverage).

When a beneficiary transfers to another provider at the same level of care (e.g., a

beneficiary transfers from one SNF to another while remaining in a Medicare-covered

SNF stay).

When a provider discontinues care for business reasons (e.g., an HHA refuses to continue

care at a home with a dangerous animal or because the beneficiary was receiving physical

therapy and the provider’s physical therapist leaves the HHA for another job).