Home Health Change of Care Notice (HHCCN) (CMS-10280)

Forms and Documents

Document Name	Status
Form CMS-10280 Home Health Change of Care Notice (HHCCN) Form	Modified
Response to Public Comments.docx Supplementary Document	2021-11-08
CMS-10280 - Supporting Statement A_.docx Supporting Statement A	2021-11-08

IC Document Collections

IC ID	Document Title	Status
206099	Home Health Change of Care Notice (HHCCN) Form	Modified

ICR Details

OMB Control No: 0938-1196	ICR Reference No: 202111-0938-004
Status: Received in OIRA	Previous ICR Reference No: 201903-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Home Health Change of Care Notice (HHCCN) (CMS-10280)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/09/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2022
Responses	12,385,108	13,640,524
Time Burden (Hours)	824,848	908,459
Cost Burden (Dollars)	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 42 USC 1395bbb Name of Law: CONDITIONS OF PARTICIPATION FOR HOME HEALTH AGENCIES; HOME HEALTH QUALITY
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 46854	08/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 61767	11/08/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Home Health Change of Care Notice (HHCCN)	CMS-10280, CMS-10280	Aviso de Cambio del Cuidado de la Salud en el Hogar (HHCCN) ,   Home Health Change of Care Notice (HHCCN)

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ICR Summary of Burden

	Total Request	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	12,385,108	13,640,524	0	0	-1,255,416	0
Annual Time Burden (Hours)	824,848	908,459	0	0	-83,611	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The annual hour burden associated with this collection is estimated to be 824,848 hours. The annual hour burden associated in the prior PRA submission for this collection was 908,459 hours which decreases the annual hour burden by 83,611. The decrease in the burden estimates is likely due to a decrease in the annual number of home health episodes (from 6,660,412 to 6,047,416) which would cause a decrease in the number of HHCCNs issued annually per respondent (from 13,640,524 to 12,385,108).

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/09/2021

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