OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Home Health Change of Care Notice (HHCCN)

ICR 201303-0938-009 · OMB 0938-1196 · Historical Active

Forms and Documents
Document
Name
Status
Form
 New
Supplementary Document
2013-03-07
Supporting Statement A
2013-03-07
IC Document Collections
IC ID
Document
Title
Status
206099 New
ICR Details
0938-1196 201303-0938-009
Historical Active
HHS/CMS 19118
Home Health Change of Care Notice (HHCCN)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/10/2013
Retrieve Notice of Action (NOA) 03/11/2013
  Inventory as of this Action Requested Previously Approved
06/30/2016 36 Months From Approved
14,126,428 0 0
941,385 0 0
0 0 0
The Centers for Medicare and Medicaid Services (CMS) requests a new collection named the Home Health Change of Care Notice (HHCCN), Form CMS -10280, to replace, in part, the existing, previously approved Office of Management and Budget (OMB) notice, titled the Home Health Advance Beneficiary Notice (HHABN) (CMS-R-296). The use of written notices to inform beneficiaries of their liability under specific conditions has been available since the "limitation on liability" provisions in ?1879 of the Act were enacted in 1972 (P.L. 92-603). The revised Advanced Beneficiary Notice of Noncoverage (ABN) for conveying information on beneficiary liability is approved by OMB, consistent with the Paperwork Reduction Act of 1995 (PRA); however, HHAs have been historically excluded from using the ABN as a liability notice for their services and have used the HHABN exclusively. In an effort to streamline, reduce, and simplify appeals notices issued to Medicare beneficiaries, the appeals portion of the HHABN will be replaced by the existing ABN (CMS -R-131) which is presently used by providers other than HHAs to inform Fee For Service (FFS) Medicare beneficiaries of potential liability for certain items/services that might be billed to Medicare. Pursuant to a separate PRA package revising the use of the ABN, HHAs will now use the ABN for liability notification, and the HHCCN will be introduced as a separate, distinct document to give change of care notice in compliance with HHA COPs.
US Code: 42 USC 1395bbb Name of Law: CONDITIONS OF PARTICIPATION FOR HOME HEALTH AGENCIES; HOME HEALTH QUALITY
  
US Code: 42 USC 1395bbb Name of Law: CONDITIONS OF PARTICIPATION FOR HOME HEALTH AGENCIES; HOME HEALTH QUALITY
Not associated with rulemaking
  77 FR 74018 12/12/2012
78 FR 13058 02/26/2013
Yes
1
IC Title Form No. Form Name
Notice CMS-10280 Home Health Change of Care Notice
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 14,126,428 0 14,126,428 0 0 0
Annual Time Burden (Hours) 941,385 0 941,385 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new information collection request.
$0
No
No
No
No
No
Uncollected
William Parham 4107864669
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/11/2013