Being Discharged From Home Health: The Notice, and the Fast Appeal

About half of people on Medicare who live at home say they know how to file a complaint or appeal with Medicare. That's from CMS's Medicare Current Beneficiary Survey, 2025 preliminary estimates. Fewer say so among the people most likely to be on home health.

These tables don't break out home health patients. The ADL row, people with limitations in three or more activities of daily living, is the closest stand-in I have for a home health patient. The numbers in parentheses are CMS's margins of error.

So when home health is ending, there's a good chance your parent doesn't know a fast appeal exists. The family has to. I'm an occupational therapist, and I've worked inside home health agencies. Here is the notice the agency must give, and what you can do with it.

The Notice: "Notice of Medicare Non-Coverage"

When Medicare-covered home health is ending, the agency must give your parent a standard form called the Notice of Medicare Non-Coverage. Its form number is CMS-10123. Most people call it the NOMNC. The rule is 42 CFR §405.1200, and CMS's billing manual says "A NOMNC must be delivered even if the beneficiary agrees with the termination of services."

The top of the form says Medicare coverage of your current home health services will end on a date the agency fills in, the last covered day. Then it says "You may have to pay for any services you get after this date." It also says that if you appeal, "Your services will continue during the appeal", and that you "don't have to prepare anything in writing".

When it has to arrive

CMS's instructions say the NOMNC "must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily." They add: "The two-day advance requirement is not a 48-hour requirement."

If visits aren't daily, the second half matters. The manual's example: "if home health care is provided on Tuesdays and Thursdays, and Tuesday is the last day of Medicare covered services, the notice must be delivered no later than the preceding Thursday."

There's one exception. If the agency finds your parent is no longer homebound, the manual says the NOMNC "should be immediately delivered" when the agency discovers it. If that's the reason, our homebound status walkthrough explains what homebound means.

Signing it

Signing says you got the notice and understand it, not that you agree. If you refuse to sign, the date you refused counts as the date you got it, and you "remain entitled to an expedited determination," the manual says.

If you're the representative and live elsewhere, the agency can phone you at least two days before services end and mail a copy. The date of that call counts as the date you got the notice. Pick up the agency's calls near the end of care.

When There's No NOMNC

Not every ending gets this notice. The fast appeal is about one thing: Medicare-covered care ending because, in the rule's words, services are "no longer reasonable and necessary" or "no longer covered" (§405.1202(f)(1)(i)).

CMS's manual lists cases where the agency should not give a NOMNC. The home health ones:

• A cut, not an ending. "When services are being reduced (e.g., an HHA providing physical therapy and occupational therapy discontinues the occupational therapy)." The rule says the same: "A termination does not include a reduction in services." If nursing stops but therapy continues, there's no NOMNC yet.
• A move to a higher level of care, "e.g., home health care ends because a beneficiary is admitted to a SNF."
• Your parent stops on their own.
• The agency stops 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."
• Care that was never covered, for example "a face-to-face visit was not conducted for the initial episode of home health care."

The fast appeal doesn't apply to those. But an agency can't discharge for just any reason. Medicare's rule lists the only ones it may use, and our guide to home health patient rights and how to complain has that list, plus your right to notice before services are cut. If the discharge came after a hospital admission, see back in the hospital during home health.

How to Ask for a Fast Appeal

The reviewer is the Beneficiary and Family Centered Care Quality Improvement Organization, the BFCC-QIO. The NOMNC calls it "the independent reviewer authorized by Medicare" and prints its name and toll-free number.

The deadline

The NOMNC says: "You must ask for a timely appeal no later than noon of the day before the above date." The "above date" is the end date printed on the form. If coverage ends Friday, that's noon Thursday.

The federal rule words it another way: "no later than noon of the calendar day following receipt of the provider's notice of termination" (42 CFR §405.1202(b)(1)). When the notice comes exactly two days before the end date, those land on the same day. When visits aren't daily and the notice comes earlier, at the next-to-last visit, the rule's clock can run out first. My advice, not a rule: call the day the notice arrives. That way you're inside both.

The rule allows a request "in writing or by telephone," and CMS's manual says QIOs take requests "24 hours a day, 7 days a week." Stay reachable after you call. The reviewer will have questions.

The doctor's statement (home health only)

This is the step families miss, and it's not on the form. For home health, the rule gives the fast appeal right when the patient disagrees and "a physician certifies that failure to continue the provision of the service(s) may place the beneficiary's health at significant risk" (§405.1202(a)(1)).

CMS's manual calls it "a written statement from any licensed physician contacted by a beneficiary" and says without it "a QIO may not make a determination" for home health. You don't need it before you call. Once you've asked, the QIO "will instruct the beneficiary on how to obtain the necessary certification from a physician."

So, the same day: call the QIO, then call the doctor who knows your parent best and say you need that statement for a Medicare fast appeal.

What Happens Next

The detailed explanation (DENC)

The rule says the QIO must "immediately notify" the agency when it gets your request. The agency then owes you a second form, the Detailed Explanation of Non-Coverage (CMS-10124), or DENC. CMS's instructions say it "must be provided no later than close of business of the day of the QIO's notification."

The DENC has to give "the facts used to make this decision" and a "detailed explanation of why your services are no longer covered, and the Medicare coverage rules used to make this decision." The agency may phone you with the contents and send a paper copy by tracked mail.

Read it closely. If the facts are wrong, say so to the QIO. "My mother still can't get to the bathroom alone" is useful. "She needs more help" is not. The rule lets you "submit evidence," and you can ask the agency for copies of everything it sent the QIO. The agency must provide them by the end of the next day and may charge "a reasonable amount" for copying.

The review and the decision

Under the rule, "the burden of proof rests with the provider." The agency has to show ending coverage is right. The QIO must ask your parent's views, look at the records, and let the agency explain. It must decide "No later than 72 hours after receipt of the request" and notify your parent, the doctor and the agency. The NOMNC puts it for families: a decision "generally no later than two days after the effective date above."

What It Costs

What you might pay depends on timing and on the outcome.

• The last covered day. The manual says "Beneficiaries have no liability for services received on this date, but may face charges for services received the day following the effective date."
• During the appeal. If you asked on time, "the provider may not bill the beneficiary for any disputed services until the expedited determination process (and reconsideration process, if applicable) has been completed" (§405.1202(g)).
• If the QIO agrees with the agency. Medicare.gov: "You won't be responsible for paying for any SNF, HHA, CORF, or hospice services provided before the coverage end date on the 'Notice of Medicare Non-Coverage.' If you continue to get services after the coverage end date, you may have to pay for those services."
• If the notice was late or incomplete. The agency "is financially liable for continued services until 2 days after the beneficiary receives valid notice" or the end date on the notice, whichever is later (§405.1200(b)(5)).

The NOMNC itself says "If you stop services by the above date, you'll avoid financial liability." Keeping visits going during the appeal is your family's call. Ask the agency what a visit would cost if the decision goes against you.

If the QIO Says Care Should Continue

Medicare may keep covering it. Medicare.gov says, "Depending on your care needs, Medicare may continue to cover your ... home health agency ... services."

One catch. The agency still needs a doctor's orders. CMS's manual says that if "the physician has already concurred with the termination of care, providers cannot deliver care" until orders are back. The ordering doctor "should be made aware the QIO has ruled coverage should continue, and be given the opportunity to reinstate orders." Your parent may also find another doctor to write orders, or another agency. So after a win, call the doctor's office and the agency the same day.

If care continues and later ends again, the agency gives a new NOMNC, and you can appeal again.

If the QIO Agrees With the Agency

You can take it one step further. The next reviewer is a Qualified Independent Contractor (QIC). The rule says to ask "by no later than noon of the calendar day following initial notification" of the QIO's decision, by phone or in writing, and the QIC must decide within 72 hours unless you ask for more time (42 CFR §405.1204). The QIO's decision letter must tell you how to ask.

If You Missed the Deadline

You still have options, with less protection. CMS's manual says you have "up to 60 days from the effective date of the NOMNC to make an untimely request to a QIO." If your parent is still getting services, the QIO must decide "within 7 days of receipt of the request." If services have stopped, "within 30 days." And "The coverage protections discussed in 260.4.2 do not apply," meaning the agency's bar on billing during the appeal is gone.

If Your Parent Has Medicare Advantage

The same notice applies. CMS's NOMNC instructions cover Medicare Advantage plans and their "enrollees receiving covered ... home health" services, and the plan rule (42 CFR §422.624) uses the same two-day timing.

What differs: the decision to end coverage is the plan's, and the plan writes the detailed explanation (§422.626(e)). The plan rule says to ask "by noon of the first day after the day of delivery of the termination notice" (§422.626(a)(1)). The NOMNC says that in a health plan, "the QIO generally will let you know its decision by the effective date above." If you miss the deadline, the notice must tell you about the plan's other appeals (§422.624(b)(2)(iii)). Two more differences. The plan rule doesn't include the doctor's statement that Original Medicare's rule asks for (§405.1202(a)(1)). And if the reviewer sides with the plan, the next step is to ask the same reviewer to reconsider, "no later than 60 days after notification" that it upheld the plan's decision (§422.626(g)(1)). Our guide to Medicare Advantage prior authorization for home health explains how plan approvals work.

What I'd Do the Day the Notice Comes

None of this is a rule. It's what I'd do for my own family.

• Find the end date and the QIO's number. Both are on page one. Write the noon deadline on the calendar.
• Ask the clinician why. Sometimes the goals really are met. Sometimes the answer doesn't match how your parent is doing.
• If you disagree, call the QIO that day. Then call the doctor's office about the statement.
• Write down what your parent still can't do safely. Bathing, stairs, medicines, getting to the toilet at night. Specific beats general.

If home health ends and your parent still needs help, see what home health does not cover. If things change later, the Does my parent qualify checker walks through Medicare's home health rules.

Frequently Asked Questions

What is a Notice of Medicare Non-Coverage for home health?

It's a two-page Medicare form, CMS-10123, often called the NOMNC. The home health agency must give it when all Medicare-covered home health is ending. It shows the last covered day, says you may have to pay for services after that date, and explains how to ask for a fast appeal by calling the Quality Improvement Organization (QIO) named on the form.

What is the deadline for a home health fast appeal?

The notice says you must ask "no later than noon of the day before the above date", meaning the end date printed on it. The QIO takes requests 24 hours a day, 7 days a week. My advice is to call the day the notice arrives.

Do we have to pay for home health while the appeal is going on?

If you ask in time, the agency may not bill you for the disputed services until the appeal is finished. If the reviewer agrees with the agency, you may have to pay for services you got after the end date on the notice. If you miss the deadline, that billing protection does not apply.

Does Medicare Advantage use the same notice?

Yes. CMS's instructions say the same notice goes to people in Medicare Advantage plans who are getting covered home health. With a plan, it is the plan's decision to end coverage, and the plan writes the detailed explanation if you appeal.

Sources

• 2025 Medicare Beneficiaries' Knowledge of Their Right to File a Complaint or an Appeal, preliminary estimates (CMS, Medicare Current Beneficiary Survey)
• 42 CFR §405.1200, Notifying beneficiaries of provider service terminations (Cornell LII)
• 42 CFR §405.1202, Expedited determination procedures (Cornell LII)
• 42 CFR §405.1204, Expedited reconsiderations (Cornell LII)
• 42 CFR §422.624, Notifying enrollees of termination of provider services (Cornell LII)
• 42 CFR §422.626, Fast-track appeals of service terminations (Cornell LII)
• FFS & MA NOMNC/DENC: forms and instructions, effective January 2025 (CMS)
• Medicare Claims Processing Manual, Chapter 30, §260, Expedited Determinations of Provider Service Terminations (CMS)
• Fast appeals (Medicare.gov)