Medicare Advantage enrollees must receive a notice at least two days before planned termination of Medicare coverage of their skilled nursing facility (SNF), home health agency (HHA) or comprehensive outpatient rehabilitation facility (CORF) services. Enrollees then may request an independent review of the Medicare Advantage organization’s decision to end coverage of SNF, HHA or CORF services. In the event of a timely appeal request, a Medicare Advantage organization must issue a second, detailed notice that explains the reasons why Medicare coverage should end.
The Centers for Medicare & Medicaid Services (CMS) has designated TMF to conduct the first fast-track review for Texas Medicare Advantage enrollees. The Medicare Advantage organization must provide the second, detailed notice to both the QIO and the enrollee. For more information including the notices please click here.
For TMF appeal contact information click here.