Not to further complicate the notice of noncoverage issue but for facilities that contract with Medicare+Choice (Soon to be MedicareAdvantage thanks to the Rx drug legislation) plans they have new requirements when a notice of noncoverage or termination of benefits is made. Like the original "Sarasett" notices, these are a spin-off of another lawsuit settlement - the Grijalva lawsuit.
-----Original Message----- From: Skilled Nursing Facility (SNF) [mailto:[EMAIL PROTECTED] Behalf Of SNF-L SNF-L Sent: Wednesday, December 03, 2003 3:32 PM To: [EMAIL PROTECTED] Subject: New Enrollee Rights, new Provider Responsibilities in M+C Program Beginning on January 1, 2004, enrollees of Medicare+Choice (M+C) plans will have the right to an expedited review by a Quality Improvement Organization (QIO) when they disagree with their M+C plan's decision that Medicare coverage of their services from a skilled nursing facility (SNF), home health agency (HHA), or comprehensive outpatient rehabilitation facility (CORF) should end. This new right stems originally from the Grijalva lawsuit (which was established in regulations in a final rule published on April 4, 2003) and entails certain new responsibiltites for HHAs, SNFs, and CORFs. See our article at: http://www.cms.hhs.gov/medlearn/pubs.asp#art STATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. immediately at either (617) 542-6000 or at [EMAIL PROTECTED], and destroy all copies of this message and any attachments. /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
