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:

•   Home Health Change of Care Notice (HHCCN) (ZIP)
•   Advance Beneficiary Notice of Noncoverage (ABN)
•   Notice of Medicare  Non-coverage (NOMNC)
•   Detailed Explanation of Non-coverage (DENC)

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. 

DECEMBER 2021: The HHCCN, Form CMS-10280, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the renewed form with the expiration date of 12/31/2024 will be mandatory on 4/30/2022.

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

Page Last Modified:
09/06/2023 04:51 PM