CMS-10280 Crosswalk

CROSSWALK DOCUMENT FOR CHANGES TO CMS-10280
(Home Health Change of Care Notice)
SUBMITTED FOR COLLECTION OCTOBER 2021

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 and form instructions
have been updated to include other provider types (i.e. physician assistants, nurse
practitioners, and clinical nurse specialists) who can certify the need for home health
services and order services following an interim final rule that was published May 8,
2020. There are no changes that will affect existing HHCCN users.
The following changes have been made to the instructions:
•
•

The term “physician/provider” takes the place of any language where only
“physician,” “ordering physician,” or “doctor” was used.
Language was added to the form instructions indicating the changes to the HHCCN
and explaining the interim final rule published May 8, 2020, which revised §§ 409.41

through 409.48; 424.22; 424.507(b)(1); § 440.70(a)(2) and (3), and (b)(1), (2) and (4); and
several sections of 42 CFR part 484.

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