Home Health Change of Care Notice (HHCCN), Form CMS-10280

60 - Home Health Change of Care Notice (HHCCN), Form CMS-10280 (Rev. 2781, Issued: 09-06-13, Effective: 12-09-13, Implementation: 12-09-13) This section provides the standards for use by home health agencies (HHAs) in implementing the Home Health Change of Care Notice (HHCCN), Form CMS-10280, requirements. The HHCCN is issued to Original Medicare beneficiaries before reducing or terminating most ongoing care provided by the HHA. HHCCN Quick Glance Guide This is an abbreviated reference tool and is not meant to replace or supersede any of the directives contained in Section 60. Notice Name Home Health Change of Care Notice (HHCCN) Notice Number Form CMS-10280 Issued by Home Health Agency (HHA) provider Recipient Original Medicare (fee for service) beneficiary receiving home health care Pertinent Information The HHCN replaces HHABN Option Box 2 and Option Box 3. The Advance Beneficiary Notice of Noncoverage (ABN), CMS-R-131, replaces HHABN Option Box 1. See section 50 for ABN information and instructions. Change of care notice Prior to the HHA reducing or discontinuing care listed in the beneficiary’s plan of care (POC) for administrative reasons specific to the HHA on that occasion Immediately on determination, or if possible, provide enough time for the beneficiary to arrange to obtain the reduced or discontinued home health care service(s) from a different HHA. No. Prior to the HHA reducing or discontinuing Medicare covered care listed in the POC because of a physician ordered change in the plan of care or a lack of orders to continue the care Notify the beneficiary before the actual reduction or discontinuation, if possible. No. The HHCCN replaces the Home Health Advance Beneficiary Notice (HHABN), CMS-R- 296, Option Box 2 and Option Box 3. Option Box 1 of the HHABN is replaced by the existing Advance Beneficiary Notice of Noncoverage (ABN),CMS-R-131, which is detailed in Section 50 of this chapter. HHAs should begin using the ABN and HHCCN in place of the HHABN as soon as possible since the HHABN will be discontinued. The date for mandatory use of the HHCCN and ABN in place of the HHABN will be posted on the web link for home health notices at http://www.cms.gov/Medicare/Medicare- General-Information/BNI/index.html. Table 1 HHA Notice Changes Instead of: Use: HHABN Option Box 1 ABN (CMS-R-131) HHABN Option Box 2 HHCCN HHABN Option Box 3 HHCCN