OMB control number
Home Health Change of Care Notice (HHCCN) (CMS-10280)
OMB 0938-1196 · HHS/CMS.
OMB 0938-1196
Home health agencies (HHAs) are required to provide written notice to original Medicare beneficiaries under various circumstances involving the initiation, reduction, or termination of services consistent with Home Health Agencies Conditions of Participation (COPs) as set forth in section 1891 of the Social Security Act (the Act) and subsequent to the decision of the US Court of Appeals (2nd Circuit) in Lutwin v. Thompson. The notice used to fulfill these requirements is the HHCCN.
The latest form for Home Health Change of Care Notice (HHCCN) (CMS-10280) expires 2027-11-30 and is listed under ICR 202409-0938-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10280 Home Health Change of Care Notice (HHCCN) | Form |
 CROSSWALK DOCUMENT HHCCN v2024.pdf | Supplementary Document |
| CMS-10280 - Supporting Statement A_.docx | Supporting Statement A |
 Home Health Change of Care Notice (HHCCN) |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202409-0938-006 | Extension without change of a currently approved collection | 2024-09-06 | ||
| 202111-0938-004 | Extension without change of a currently approved collection | 2021-11-09 | Approved without change | |
| 201903-0938-002 | Revision of a currently approved collection | 2019-03-07 | Approved without change | |
| 201604-0938-004 | Revision of a currently approved collection | 2016-04-11 | Approved with change | |
| 201303-0938-009 | New collection (Request for a new OMB Control Number) | 2013-03-11 | Approved without change |