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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say beginning January 1, 2022, home health agencies (HHAs) will no longer submit Requests for 
Anticipated Payment (RAPs). Instead, for each admission to home health the HHA notifies Medicare systems 
via submission of a Notice of Admission (NOA). The NOA is a one-time submission to establish that the 
beneficiary is under a home health period of care and trigger home health consolidated billing edits. The NOA 
covers contiguous 30-day periods of care until the individuals is discharged from Medicare home health 
services. All HHAs must submit an NOA to their Medicare contractor within 5 calendar days from the start of 
care date to establish that the beneficiary is under a Medicare home health period of care and also to trigger 
home health consolidated billing edits. In instances where an NOA is not timely-filed, Medicare shall reduce 
the payment for a period of care, including outlier payments, by the number of days from the home health 
admission date until the date the NOA is submitted to, and accepted by, the contractor, divided by 30. This 
reduction shall be a provider liability, and the provider shall not bill the beneficiary for it. You can find this 
information in the Centers for Medicare and Medicaid Services, Internet-Only Manual, Publication 100-02, 
Medicare Benefit Policy Manual, Chapter 7, Section 10.4. 
 
The rules say that home health agencies (HHAs) must send the notice of admission (NOA) to the A/B MAC by 
mail, electronic data interchange (EDI), or direct data entry (DDE). EDI submissions require additional data 
not required by the NOA itself, to satisfy transaction standards. This data is described in a companion guide 
available on the Centers for Medicare and Medicaid Services website. HHAs may voluntarily agree to adopt 
the companion guide and use it to submit EDI NOAs at any time. The admission date on the NOA must always 
match the from date. You can find these rules in the Centers for Medicare and Medicaid Services, Internet 
Only Manual, Medicare Claims Processing Manual, Chapter 10, Section 40.1. 
 
 
 
 The rules also say that for all beneficiaries receiving HH services in 2021 whose services will continue in 2022, 
the HHA shall submit an NOA with a one-time, artificial 'admission' date corresponding to the "From" date of 
the first period of continuing care in 2022. For example, if a period of care begins in 2021 and ends on January 
10, 2022, the HHA submits and NOA with an admission date of January 11, 2022 and then submits a claim 
when the 30-day period of care is over. The HHA should submit the January 11, 2022 admission date on all 
subsequent claims until the beneficiary is discharged and another NOA is required. This is to ensure the claim 
is matched to the correct NOA and the correct receipt date is used for payment. You can find this rule in the 
Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare Claims Processing Manual, 
Chapter 10, Section 10.1.10.3. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.