Crosswalk Document for Changes to ABN v2012

Crosswalk Document for Changes to CMS-R-131

Advance Beneficiary Notice of Noncoverage

Submitted for Collection October 2012

Summary of Changes to CMS-R-131:

The Advance of Beneficiary Notice of Noncoverage (ABN) is delivered to beneficiaries in certain instances by Part B paid physicians, providers (including institutional providers like outpatient hospitals) practitioners (such as chiropractors), and suppliers, as well as hospice providers and Religious Non-medical Health Care Institutions paid under Part A to beneficiaries. Delivery of this liability notice is required prior to beneficiaries receiving items or services that might not be paid for by Medicare. Other Medicare institutional providers paid under Part A use other approved notices for this purpose. The ABN was last approved under PRA in 2011 following minimal and nonsubstantive changes to comply with Section 508 of the Rehabilitation Act of 1973, as amended in 1998, which requires Federal agencies to ensure that information is accessible to the general public.

Historically, home health agencies (HHAs) have used the Home Health Advanced Beneficiary Notice (HHABN) (CMS-R-296) as a liability and change of care notice delivered to beneficiaries when required. In an effort to streamline and simplify notices to beneficiaries, the liability portion known as the “Option Box 1” of the HHABN will now be represented by the existing ABN. The change of care notification portion of the HHABN will be delivered via the new Home Health Change of Care Notice (HHCCN) (CMS-10280) which is the subject of a separate PRA package. Accordingly, the HHABN will be discontinued from use.

This package incorporates expanded use by HHAs as reflected in the revised instructions. No substantive changes have been made to the form. There are no changes that will affect existing ABN users.

The following changes have been made to the instructions:

• Exclusion of HHAs from using the ABN has been removed from the “Overview”.

• Information on HHAs using the ABN and discontinuation of the HHABN has been included in the “Overview”

• The website link for HHAs to access additional information on discontinuation of the HHABN and the use of the ABN and HHCCN has been added to the “Overview”.

The ABN is an existing collection and is in use. HHAs have previously used the HHABN, Option Box 1 as the ABN equivalent. It is our expectation that the addition of HHAs as users of the ABN will have little effect on burden for all users.