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CMS Revises Home Health ABN

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  • January 27, 2012
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Effective Feb. 3, the Centers for Medicare & Medicaid Services (CMS) requires that home health providers use a revised home health advanced beneficiary notice (HHABN) to inform fee-for-service Medicare beneficiaries about possible non-covered charges when limitation of liability applies.
Per chapter 30, section 60, of the Medicare Claims Processing Manual, “The HHABN is issued to Original Medicare beneficiaries in advance of furnishing what HHAs believe to be noncovered care, and … also … before reducing or terminating most ongoing care provided by the HHA.”
HHAs must complete and deliver HHABNs according to the Advance Beneficiary Notice Standards. The revised HHABN now includes three option boxes:
1. Financial Liability Notice — to be issued prior to the HHA providing an item or service that Medicare usually covers, but may not pay for in this instance because of one of the following reasons:

  • the item or service is not medically reasonable and necessary;
  • the beneficiary is not confined to his or her home;
  • the beneficiary does not need skilled nursing care on an intermittent basis; or
  • the beneficiary is receiving custodial care only.

2. Change of Care Notice (due to agency reasons) — to be issued prior to the HHA reducing or discontinuing care listed in the beneficiary’s plan of care for reasons specific to the HHA on that occasion.
3. Change of Care Notice (due to physician’s orders) — to be issued prior to the HHA reducing or discontinuing Medicare covered care listed in the plan of care because of a physician-ordered change in the plan of care or a lack of orders to continue the care.
The HHABN may be optional in the first instance above, but not in the second or third instances. Notices must be delivered to the patient either prior to delivery of services, or immediately upon determination of reduced/discontinued care.
For complete instructions on the revised HHABN, see CMS Transmittal 2362, Change Request 7323. An additional summary of the changes may be found in MLN Matters® MM7323.

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