Page 12 - Home Health Marketing

You or your authorized representative will receive and be asked to sign and
date a Notice of Medicare Non-Coverage (NOMNC) at least two days before
your covered Medicare services will end. If you or your authorized
representative are not available, we will make contact by phone, and then
mail the notice. If you do not agree that your covered services should end,
you must contact the Quality Improvement Organization (QIO) at the phone
number listed on the form no later than noon of the day before your services
are to end and ask for an immediate appeal. IF YOU HAVE YOUR
NOTICE OF NONDISCRIMINATION OWN NONDISCRIMINATION
NOTICE, PLEASE ATTACH
Your Agency Name complies with applicable federal civil rights laws and
does not discriminate, exclude or treat people differently on the basis of social
status, political belief, race, color, religion, national origin, sex (including
sexual orientation and gender identity), age or disability with regard to
admission, access to treatment or employment.

Your Agency Name provides free aids and services to people with disabilities
to communicate effectively with us, such as qualified sign language
interpreters, written information in other formats (large print, audio,
accessible electronic formats, other formats); and free language services to
people whose primary language is not English, such as qualified interpreters
and information written in other languages. If you need these services, please
contact Agency Name.

CONTACTING YOUR CLINICAL MANAGER

Your Clinical Manager coordinates your home health care, assesses your needs
and assists with the development, implementation and updating of your plan
of care. Contact information for your Clinical Manager is provided on the back
cover of this booklet. Reasons to contact your Clinical Manager include, but
are not limited to:
Questions about your plan of care or schedule;
Requests for additional services;
Requests for discharge or to refuse care; or

Complaints about your care.

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