Notice of Discharge and Medicare Appeal Rights Citations and

7045 - Notice of Discharge and Medicare Appeal Rights Citations and Authority - (Rev. 4, 07-18-03) Section 4001 of the Balanced Budget Act of 1997 (BBA) (Public Law 105-33) enacted August 5, 1997, added §§1851 through 1859 to the Social Security Act (the Act) to establish a new Part C of the Medicare program known as the Medicare + Choice (M+C) Program. Medicare Part C establishes a new authority permitting contracts between CMS and a variety of different managed care and fee-for-service entities (e.g., coordinated care plans). Regulations require that each M+C enrollee must receive a Notice of Non- coverage (NONC) before being released from the hospital once it is determined that inpatient hospital care is no longer necessary (See 42 CFR 422.620). The NONC is now referred to as the Notice of Discharge and Medicare Appeal Rights (NODMAR). The enrollee remains entitled to inpatient hospital care until he/she receives the NONC of that care. An enrollee or his/her representative that disagree with the hospital or M+C determination may only obtain QIO review of the NODMAR by requesting an immediate QIO review (See 42 CFR 422.622). Until January 1, 2003, existing cost-based contracts established under §1876 of the Act are governed by regulatory provisions in 42 CFR Part 417 (See §1876(h)(5)(B)). Included in that Part are two protections available to managed care enrollees who believe they are being discharged prematurely from a hospital: immediate QIO review as provided by 42 CFR 417.605 or expedited internal review by the HMO or CMP (See 42 CFR 417.609). The regulatory authority for these organizations to issue NODMARs is found at 42 CFR 417.440(f).