Home health agencies (HHAs) are responsible for issuing the following beneficiary rights and protections notices to Original Medicare (fee for service - FFS) beneficiaries when notice is required:
The HHCCN, Form CMS-10280, is used to notify Original Medicare beneficiaries receiving home health care benefits of plan of care changes. HHAs are required to provide written notification to beneficiaries before reducing or terminating an item and/or service.
The Office of Management and Budget (OMB) has approved the Home Health Change of Care (HHCCN) Form, CMS-10280. Effective July 1, 2019, all Home Health Agencies (HHA) will be required to use the renewed form with the expiration date of 4/30/2022 on the bottom. Please note that HHAs may continue to use the old form up until July 1, 2019, but we encourage HHAs to begin transitioning to the renewed form. There have been no changes made to the form.
To download the HHCCN and its corresponding instructions (found in the Medicare Claims Processing Manual, 100-4, Chapter 30), please click on the links below under "Downloads".
Questions regarding the HHCCN, ABN, NOMNC and DENC can be submitted at: https://appeals.lmi.org