Update on HHABN: New Form Available

The Revised Home Health Advance Beneficiary Notice (HHABN) is mandated to be implemented April 1, 2011.  However, CMS has made Form CMS-R-296 available for use immediately.

The regulation as to application remains the same. HHABN notices MUST be issued whenever home health coverage is reduced or discontinued  (with limited exception).  The notices are issued to beneficiaries receiving the home health benefit for notification of potential financial liability and/or plan of care changes.

The new form has had minor changes. It continues to include an interchangeable Option Box with flexibility to insert Option Box 1, 2, or 3 on the form that is given to the beneficiary. The Option Box is unchanged with the current form dated 8/31/2009.

Form Triggering Events

There were no changes as to triggering events. The form must be delivered to the beneficiary upon the following:

·            Initiation – “When a HHA expects that Medicare will not cover any planned items and/or services from the start of the course of treatment given over a spell of illness, OR before the delivery of one-time items or services that Medicare is not expected to cover.”

·            Reduction – “When a HHA reduces or stops some items and/or services during a spell of illness, while continuing others, including when one home health discipline ends but others continue.”

·            Termination – “When a HHA ends delivery of all Medicare-covered care, but expects to continue delivering noncovered care.” Source: CMS HHABN Form Instruction OMB 0938-0781

NOTE: If the termination involves the end of all Medicare covered care and no further care is to be delivered, the only notice necessary, per CMS, would be an Expedited Determination Notice (CMS-10123).

NOTE: For indepth information regarding the HHABN process, see Chapter 30, 40.3.5 of the Medicare Claims Processing Manual.

HHABN Sections

The HHABN will continue to be a one-page notice:

·            Header

·            Body

·            Option Boxes

·            Signature/Date Section

On the CMS website, an agency will find a “Sample” HHABN Form with instructions as well as three “agency ready” samples.  Each sample form has Option Box text for each choice; Option Box 1, or 2, or 3.

Remember, an agency may customize the header section using their logo, name, and billing address.

For a complete list of instructions for use as well as the exact changes, go to

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