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Skilled Nursing Facilities (SNFs) must issue a liability notice to Original fee-for-service (FFS) Medicare beneficiaries before the SNF provides:

  • an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
  • custodial care.

January 2018:  CMS is releasing a newly revised Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) along with newly developed, concise and separate instructions for form completion. The revised SNF ABN has the requirements from the Denial Letters and looks similar to the ABN with 3 different options for Original FFS Medicare beneficiaries to choose from. We will be discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (NEMB-SNF). Since the NEMB-SNF was used as a voluntary notice for care that is never covered by Medicare, we will continue to encourage providers to issue the revised SNF ABN in this voluntary capacity. The revised SNF ABN will be mandatory for use on May 7, 2018. During the interim, SNFs may continue to use the old version of the SNF ABN, the Denial Letters or the NEMB-SNF, however, it is recommended that the revised SNF ABN be used as soon as possible.

For Part A items and services: SNFs must use the newly revised SNF ABN as the liability notice.

For Part B items and services: SNFs must use the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The ABN and information on this notice can be found at

To download the notice and accompanying instructions, please click on the appropriate link below.


Questions regarding the SNF ABN or ABN can be emailed to