What Is a Notice of Medicare Non-Coverage in Skilled Nursing?
The Notice of Medicare Non-Coverage, or NOMNC, is a coverage notice.
It tells a person receiving skilled nursing, home health, hospice, or comprehensive outpatient rehabilitation services that Medicare-covered services are ending and explains the fast-appeal process.
A NOMNC is not the same as a nursing-home transfer or discharge notice.
When the NOMNC is delivered
CMS instructions say the NOMNC must generally be delivered at least two calendar days before Medicare-covered services end, or the second-to-last day of service when care is not provided daily.
The two-day advance requirement is not necessarily a full 48 hours.
Read the coverage-end date
The notice identifies the date Medicare coverage of the listed service will end.
Write it down immediately.
Do not rely on a verbal “coverage stops Friday.”
Fast-appeal deadline
Medicare’s current fast-appeals guidance says that for SNF, home health, CORF, or hospice services, the beneficiary should follow the NOMNC instructions and generally request the fast appeal no later than noon the day before the termination date listed on the notice.
Use the exact deadline and contact information on the notice.
Who reviews the fast appeal
A Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) conducts the independent expedited review.
If a fast appeal is requested, a Detailed Explanation of Non-Coverage (DENC) explains the specific reasons coverage is ending.
NOMNC does not automatically require the resident to leave the facility
A resident can have Medicare Part A skilled coverage end and remain in the nursing home under another payment arrangement if the facility/resident arrangements support that.
A facility-initiated discharge is governed by separate transfer/discharge rules and notices.
Ask why coverage is ending
Possible reasons differ:
- no longer meets skilled criteria;
- plan authorization termination;
- therapy/services ending;
- another coverage decision.
Benefit exhaustion at day 100 is handled differently and CMS guidance notes a NOMNC is not given solely for SNF benefit exhaustion.
NOMNC review card
Notice received: ____________________
Service ending: ____________________
Coverage-end date: ____________________
Fast-appeal deadline on notice: ____________________
BFCC-QIO contact: ____________________
Reason given: ____________________
DENC requested/received: ____________________
Separate facility discharge notice?: Yes / No
Frequently asked questions
Should I sign the NOMNC?
Signing acknowledges receipt; it does not necessarily mean you agree with the termination decision. Read the form carefully.
Is the deadline always two days before coverage ends?
The notice is generally delivered at least two calendar days before, but the fast-appeal request deadline is tied to the instructions on the notice—generally noon the day before termination.
Does a NOMNC mean Medicare will never pay again?
No. It addresses the current covered service termination.
The practical goal
When a NOMNC arrives, immediately identify:
what service is ending, the exact coverage-end date, the exact appeal deadline, and whether there is a separate issue about remaining in the facility.
Related NHP guides
- What Happens When Medicare Stops Paying for Rehab?
- Nursing Home Discharge Notices: How Families Can Review Their Options
Primary sources checked
*Editorial/source review: October 15, 2026. General education only. Medicare coverage depends on the individual benefit period, clinical documentation, notices, plan rules, and applicable appeal procedures.*
