Revision to Form CMS 10564 Home Health

Revision to Form CMS 10564 Home Health E-Clinical Template

The modifications made to the progress note after the publication of the 60-day notice do not add any additional burden to the providers.

Issue #	Form	Change	Attachment	Current Location	Reason
1	CMS-10564	Changed the word “specify” to “specify services needed” for each Home Health service listed in the Plan/Orders section of the progress note.	Attachment 1, Word File	Plan/Order section of the progress note.	A commenter suggested replacing “specify or “please specify” with “specify what is needed” or “specify reason needed.”
2	CMS-10564	Modified the progress note to include the title “Plan for Home Health Services” over the Face-to-Face section of the progress note.	Attachment 1, Word File	Face-to Face section of the progress note.	A commenter also suggested placing a header over the “Face-to-Face, section that says “Plan for Home Health Services”.