---
kind: "section"
citation: "42 C.F.R. § 405.1200"
title: "42"
number: "405.1200"
heading: "Notifying beneficiaries of provider service terminations."
url: "https://uscodex.org/cfr/42/405.1200"
---

# §405.1200. Notifying beneficiaries of provider service terminations.

- (a) **Applicability and scope.**
  - (1) For purposes of [§§ 405.1200 through 405.1204](/cfr/42/405.1200..405.1204.md), the term, provider, is defined as a home health agency (HHA), skilled nursing facility (SNF), comprehensive outpatient rehabilitation facility (CORF), or hospice.
  - (2) For purposes of [§§ 405.1200 through 405.1204](/cfr/42/405.1200..405.1204.md), a termination of Medicare-covered service is a discharge of a beneficiary from a residential provider of services, or a complete cessation of coverage at the end of a course of treatment prescribed in a discrete increment, regardless of whether the beneficiary agrees that the services should end. A termination does not include a reduction in services. A termination also does not include the termination of one type of service by the provider if the beneficiary continues to receive other Medicare-covered services from the provider.
- (b) **Advance written notice of service terminations.** Before any termination of services, the provider of the service must deliver valid written notice to the beneficiary of the provider's decision to terminate services. The provider must use a standardized notice, as specified by CMS, in accordance with the following procedures:
  - (1) **Timing of notice.** A provider must notify the beneficiary of the decision to terminate covered services no later than 2 days before the proposed end of the services. If the beneficiary's services are expected to be fewer than 2 days in duration, the provider must notify the beneficiary at the time of admission to the provider. If, in a non-residential setting, the span of time between services exceeds 2 days, the notice must be given no later than the next to last time services are furnished.
  - (2) **Content of the notice.** The standardized termination notice must include the following information:
    - (i) The date that coverage of services ends;
    - (ii) The date that the beneficiary's financial liability for continued services begins;
    - (iii) A description of the beneficiary's right to an expedited determination under [§ 405.1202](/cfr/42/405.1202.md), including information about how to request an expedited determination and about a beneficiary's right to submit evidence showing that services must continue;
    - (iv) A beneficiary's right to receive the detailed information specified under [§ 405.1202(f)](/cfr/42/405.1202.md?p=f); and
    - (v) **Any other information required by CMS.**
  - (3) **When delivery of the notice is valid.** Delivery of the termination notice is valid if—
    - (i) The beneficiary (or the beneficiary's authorized representative) has signed and dated the notice to indicate that he or she has received the notice and can comprehend its contents; and
    - (ii) The notice is delivered in accordance with [paragraph (b)(1)](#b-1) of this section and contains all the elements described in [paragraph (b)(2)](#b-2) of this section.
  - (4) **If a beneficiary refuses to sign the notice.** The provider may annotate its notice to indicate the refusal, and the date of refusal is considered the date of receipt of the notice.
  - (5) **Financial liability for failure to deliver valid notice.** A provider is financially liable for continued services until 2 days after the beneficiary receives valid notice as specified under [paragraph (b)(3)](#b-3) of this section, or until the service termination date specified on the notice, whichever is later. A beneficiary may waive continuation of services if he or she agrees with being discharged sooner than the planned service termination date.

## Notes

### Source

Source: 69 FR 69264, Nov. 26, 2004, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).