Skilled Nursing Facility Payment Bans or Denial of Payment for New Admissions

Under the Social Security Act at Sections 1819(h) and 1919(h) and CMS’ regulations at 42 CFR 488.417, CMS may impose a Denial of Payment for New Admissions (DPNA) against a Skilled Nursing Facility (SNF) when a facility is not in substantial compliance with requirements of participation.

A new admission occurs when a patient is admitted to an SNF where he has not previously received services. The provider is liable for services rendered during a sanction period unless a Notice of Non-Coverage is issued to the beneficiary prior to admission. It is the provider’s responsibility to notify the beneficiary, in writing that the service is non-covered and the reason why the service is non-covered.

The Notice of Non-Coverage should indicate that Medicare will not be making payment for the stay due to the DPNA. Please share with appropriate staff.