New Advanced Beneficiary Notice Policy Kicks in on May 30 for Home Health

The Centers for Medicare and Medicaid Services (CMS) recently issued a revised Home Health Advanced Beneficiary Notice (HHABN) form, which home health agencies (HHAs) will be required to use as of May 30. Between now and May 30, HHAs may continue to use the current HHABN or switch to the new version.

The new HHABNs, in English and Spanish, and accompanying instructions are available through the following CMS Web site. Click on "FFS HHABN" in the left column: http://www.cms.hhs.gov/BNI/03_HHABN.asp#TopOfPage.

The link contains eight documents, including the revised HHABN as well as the current version, approved in June 2002. Also at the link are instructions detailing when to provide the HHABN notice. CMS advises agencies to follow these instructions rather than those currently posted in the Medicare Claims Processing Manual, Chapter 30. The new instructions provide details on when to use the Option 1 text of the HHABN versus the Option 2 version. Note that the revised HHABN makes the Notice of Exclusion from Medicare benefits obsolete.

At pages 4 to 8 of the instructions, CMS outlines triggering events that will precipitate issuance of HHABNs, as well as a number of important exceptions to the notification requirement at pages 8 and 9. Included in the latter are reductions that are included in the Plan of Care, a policy for which AAHomecare vigorously advocated.

Also note that home health agencies and certain other providers have been required since July 1, 2005, to inform beneficiaries whose Medicare services are ending of their right to an expedited review process. To accomplish this, providers must issue an Expedited Determination Notice (EDN). The EDN and related instructions are available through this CMS link: http://www.cms.hhs.gov/BNI/06_FFSEDNotices.asp#TopOfPage.

Per CMS, in only one case must the HHA provide both the HHABN and EDN — in situations where Medicare services are ending but non-covered items or services will continue.

Source: American Association for Homecare

This article originally appeared in the February 2006 issue of HME Business.

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