Crosswalk

CROSSWALK DOCUMENT FOR CHANGES TO CMS-10280

(Home Health Change of Care Notice) SUBMITTED FOR COLLECTION OCTOBER 2015

SUMMARY OF CHANGES TO CMS-10280: The “Home Health Change of Care Notice (HHCCN)” is used to notify original Medicare beneficiaries receiving home health care benefits of plan of care changes. Home health agencies must provide the HHCCN whenever they reduce or terminate a beneficiary’s home health services due to physician/provider orders or limitations of the HHA in providing the specific service.

This notification is required for covered and non-covered services listed in the plan of care (POC). The HHCCN was initially approved with the 2013 PRA submission; however, with this submission, there is one minimal, non-substantive change to comply with Section 504 of the Rehabilitation Act of 1973 (Section 504), which requires Federal Agencies to be non-discriminatory and provide this publication in an alternative format if needed. No substantive changes have been made to the existing form. There are no changes that will affect existing HHCCN users.

The following non-substantive changes have been made to the form:

• The form has been revised to include language informing beneficiaries of their rights of CMS nondiscrimination practices and to request this publication in an alternative format if needed.

ThereNo changes were minor changes made to the form instructions. See enclosed document for changes. made to the form instructions.

The HHCCN is an existing collection and is in use. It is our expectation that the single, non-substantive change to the form will have little effect on burden for all users. The Section 504 requirement was in effect with the prior notice, and including standard CMS language to advise the beneficiary of nondiscrimination and availability of alternate forms of this notice is not expected to change burden associated with the HHCCN.

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