Medicare's revisions to change in ownership (CHOW) rules have officially hit the books. "Change in majority ownership occurs when an individual or organization acquires more than a 50 percent direct ownership interest in a home health agency (HHA) during the 36 months following the HHA's initial enrollment into the Medicare program or the 36 months following the HHA's most recent change in majority ownership (including asset sales, stock transfers, mergers, or consolidations)," CMS says in Jan. 20 Transmittal No. 404 (CR 7579). "This includes an individual or organization that acquires majority ownership in an HHA through the cumulative effect of asset sales, stock transfers, consolidations, or mergers during the 36-month period after Medicare billing privileges are conveyed or the 36-month period following the HHA's most recent change in majority ownership." The change was included with a general update to Chapter 15 of Medicare's Program Integ-rity Manual online at www.cms.gov/transmittals/downloads/R404PI.pdf.