Completing the HHCCN

60.4 - Completing the HHCCN (Rev. 2781, Issued: 09-06-13, Effective: 12-09-13, Implementation: 12-09-13) A. Notices and General Notice Requirements The HHCCN and the general instructions for preparing the HHCCN are available for download at the home health notice link found at http://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html. The notice is available in English and Spanish, and in PDF and Word formats. The HHCCN is the Office of Management and Budget (OMB) approved standard notice for use by Medicare HHAs to inform beneficiaries of changes in the POC when required by the COPs for HHAs. HHAs must use the OMB approved standard notice. HHAs must not add any customizations to the notice beyond what is permitted by the accompanying HHCCN form instructions and the guidelines published in this section. B. Choosing the Correct Language Version HHAs should choose the appropriate version of the HHCCN based on the language the beneficiary best understands. When a Spanish-language HHCCN is used, the HHA should make insertions on the notice in Spanish. If this is impossible, the HHA must take additional steps needed to assure beneficiary comprehension and document this on the HHCCN. If needed, HHAs must provide verbal assistance in other languages to assist beneficiaries in understanding the document. HHAs should document any types of translation assistance used in the “Additional Information” section of the notice. C. Compliance with Paperwork Reduction Act of 1995 Consistent with the Paperwork Reduction Act of 1995, the valid OMB control number for this information collection appearing on the HHCCN is 0938-1196. The estimated time required to complete this information collection is 4 minutes for a single notice. This includes the time to prepare the notice, review it with the beneficiary, and obtain the beneficiary’s signature. D. Effective Dates HHCCNs are effective for HHA use per the OMB assigned date given at the bottom of each notice unless CMS instructs HHAs otherwise. The routine approval is for 3-year use. HHAs are expected to exclusively use the effective version of the HHCCN per CMS directives.