CMS-10280 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 request for extension, the HHCCN form instructions have been
updated to remove outdated instructions from past updates (i.e. prior notice HHABN
discontinuation). These updates to the HHCCN form instructions page are nonsubstantive changes. No 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 instructions:
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•

The language regarding a discontinued document (i.e. Home Health Advance
Beneficiary Notice of Non-coverage) has been removed, as well as, the brief
description of that document.
The document has been formatted to ease readability.

The HHCCN is an existing collection and is in use. It is our expectation that the nonsubstantive change to the form instructions will have little effect on burden for all users.

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