US · guidance
CMS Pub. 100-04, ch. 30, § 70.6
Establishing When Beneficiary Is On Notice of Non-coverage
If the beneficiary has previously been informed in writing that similar or reasonably
comparable extended care items or services were non-covered and it was clear that the
beneficiary knew that the circumstances were the same, the beneficiary is liable. With
this exception, the beneficiary is presumed not to have known, nor to have been expected
to know, that the extended care items or services are not covered unless, or until, s/he
receives notification from an appropriate source.
History
(Rev.: 4198; Issued: 01-11-19; Effective: 04-30-18; Implementation: 04-30-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4c8961c2fb375177f5e8c215cba970e22f6c47d14faa0101879d4190363994d7
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