30 Day Public Comment Response

CMS Response to Public Comments Received for CMS-2019-0121

The Centers for Medicare and Medicaid Services (CMS) received several comments from
the public for CMS-2019-0121. This is the reconciliation of the comment.
Comment: The Center for Medicare Advocacy would like to express support for the
modifications to the instructions to the ABN that would be explicit in stating that
providers may not bill dually eligible beneficiaries before their claim has gone through
both Medicare and Medicaid.
Response: CMS appreciates your support regarding the changes to the ABN form
instructions.
Comment: The Medicare Rights Center welcomes and appreciates the additional special
guidance CMS included in the instructions for the ABN pertaining to individuals dually
eligible for Medicare and Medicaid and those enrolled in the QMB program.
The Medicare Rights Center encourages CMS to ensure that beneficiaries have
meaningful access to the information contained in ABNs by providing the form in the 17
languages in which the SSA routinely makes materials available. In addition, CMS
should remind providers of their obligation to ensure access to interpreter services when
appropriate.
Response: CMS appreciates your support regarding the changes to the ABN form
instructions. CMS instructs providers, suppliers, and beneficiaries to contact 1-800Medicare or email [email protected] for alternative formats of the
form. This information is located on the ABN form at the bottom. CMS also
provides our forms in large print format. These forms may be located on the ABN
website:
https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html

Comment: The Justice in Aging welcomes the additional special guidance in the form
instructions for dual eligible and commend CMS for including guidance specific to dual
eligible in the PRA submission. This additional language helps to clarify for providers
who work with dual eligible that they cannot collect for covered services and explicitly
delineates the limited circumstances under which such payment is appropriate. They also
appreciate the inclusion of recognizing potential protections in state law as well.
The Justice in Aging also appreciates the revised burden estimate. Accurate and properly
completed ABNs protect both providers and beneficiaries. Including Medicare Part B
providers in the burden analysis more accurately reflects the large swath of providers and
beneficiaries who benefit from improved clarity in the forms.

Although the supporting statement provides some language indicating the limited
circumstances under which an ABN is issued, we were surprised to find that the form
instructions themselves do not remind providers under most circumstances, ABNS are
not to be issued on a routine basis as explained in the MLN on Medicare Advance
Notices of Noncoverage, ICN 006266. We believe this MLN contains helpful reminders
about both the frequency of and prohibitions on ABN issuance that are important to
include in the form instructions for providers.
The Justice of Aging asks CMS to ensure that ABNs, as standard documents that affect
beneficiary payment responsibilities, translate the form to the 17 language in which the
SSA routinely makes materials available- English and Spanish are insufficient- and
include guidance to providers that reminds them of their obligation to ensure access to
interpreter services when appropriate.
Similarly, under the section “Completing the Notice,” the instructions direct providers to
use 12-point font, but in our experience, older adults find 14 and 16-point font more
legible, so we encourage CMS to direct providers to use a font size that older adults will
not strain to comprehend.
Response: CMS appreciates your support regarding the changes to the ABN form
instructions. CMS has more instructions regarding the ABN and when it should or
should not be issued. That instruction is located in the public online Medicare
Claims Processing Manual. The link for that online manual may be found at:
https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/clm104c30.pdf
CMS also provides, as mentioned, MLN articles that are routinely updated as well
as interactive online tutorials regarding the ABN.
CMS instructs providers, suppliers, and beneficiaries to contact 1-800-Medicare or
email [email protected] for alternative formats of the form. This
information is located on the ABN form at the bottom. CMS also provides our
forms in large print format. These forms may be located on the ABN website:
https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html