Home Health & Hospice Week

But challenges still abound.

The reprieve is over: Medicare certified home health agencies must start using the new home health advance beneficiary notice (HHABN) no later than Sept. 1.

Though the timing may not come as a surprise, the lack of attention by the Centers for Medicare & Medicaid Services to HHAs’ concerns about the revised form is a shocker, industry observers say.

In view of the efforts of representatives of agencies and trade associations to communicate the difficulties of implementing CMS’ proposals, it is very disappointing that CMS has not been more responsive, says Burtonsville, MD-based health care attorney Elizabeth Hogue.

“The final instructions are very similar to the previous set of instructions,” confirms Bob Wardwell of the Visiting Nurse Associations of America. “Essentially, there has been no response to [home health agencies’] comments,” he adds

No relief: HHAs continue to worry that filling out the form--which will now be required as a condition of participation in the fee-for-service Medicare program--will consume much more time than CMS projects. That new paperwork burden will take undue time from patient care, agencies charge.

That CMS did little to allay that concern in its final instructions is remarkable, says Hogue. The comment period that ended July 24 was ostensibly to give agencies a chance to voice concerns about the form as it relates to the Paperwork Reduction Act of 1995--which aims to minimize the paperwork burden for businesses and other parties resulting from the collection of information by or for the federal government.

When In Doubt, Deliver

As always, agencies must continue to issue an ABN in specific situations where “limitation on liability” protection applies--for example, when care is not reasonable or necessary or when a beneficiary is not homebound.

Revised burden: But with the revised ABN comes a new mandate: Moving forward, home health agencies must now also provide a standard written notice “whenever they reduce or terminate a beneficiary’s home health services.”

In its instructions, CMS spells out three general “triggering events” that should lead HHAs to issue an ABN (see “Triggering Events Chart Helps Boost Your ABN Compliance” later in this issue for more information on triggering events).

The good news: Agencies that forged ahead with training based on previous instructions should be on track for compliance, since CMS essentially left their guidance unchanged.

The bad news: Home health providers who aren’t using the form already need to make hasty preparations, says Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis.

“Getting it right” may take time, especially since some matters remain murky based on CMS guidance so far.

To date, CMS has issued two question-and-answer documents during the ABN revision process.

“Our working hypothesis is that CMS will issue another set of questions soon,” says Wardwell, adding that VNAA has yet to confirm with federal officials that they will issue a new Q&A document.

Best advice: “When in doubt, go ahead and give an HHABN, just to be on the safe side,” coaches Hogue.

Additional instructions for use of the new HHABN will be incorporated into the CMS manual system in August 2006, says CMS.

Look for: CMS has said it will issue an MLN Matters educational article on the new HHABN. It may also seek to educate HHAs in other ways, though it has not elaborated on any specific means. In addition, agencies will   have a chance to ask questions related to ABN use during the next regularly scheduled Home Health Open Door Forum, scheduled for Aug. 15 at 2 p.m. EDT.

Note: CMS has posted the final revised HHABNs and instructions at www.cms.hhs.gov/BNI/03_HHABN.asp.