CMS Pub. 100-04, ch. 30, § 400.3.3

Hospitals and CAHs must deliver the MOON to beneficiaries in accordance with section

400.2 above. Hospitals and CAHs must provide both the standardized written MOON, as

well as oral notification.

Oral notification must consist of an explanation of the standardized written MOON. The

format of such oral notification is at the discretion of the hospital or CAH, and may

include, but is not limited to, a video format. However, a staff person must always be

available to answer questions related to the MOON, both in its written and oral delivery

formats.

The hospital or CAH must ensure that the beneficiary or representative signs and dates

the MOON to demonstrate that the beneficiary or representative received the notice and

understands its contents. Use of assistive devices may be used to obtain a signature.

Electronic issuance of the MOON is permitted. If a hospital or CAH elects to issue a

MOON viewed on an electronic screen before signing, the beneficiary must be given the

option of requesting paper issuance over electronic issuance if that is what the beneficiary

prefers. Regardless of whether a paper or electronic version is issued and regardless of

whether the signature is digitally captured or manually penned, the beneficiary must be

given a paper copy of the MOON, as specified in 400.3.9, and the required beneficiary

specific information inserted, at the time of notice delivery.