The Medicare Guidance Manual Regarding Beneficiary Notifications Can Be Found Here

Beneficiary Notification

FAQ’s

NOMNC Required Use: “Notices are given to beneficiaries before the termination of all Medicare covered services. This gives clients time make an informed decision regarding their right to obtain an independent, immediate review by a Quality Improvement Organization (QIO) of the agency’s decision to end coverage.” (Sharepoint: Operations and Education > Manual – Standard Operating Procedures (SOP) > Toolbox > HHCCN – ABN with examples 6.16)

The Medicare guidance manual regarding beneficiary notifications can be found here:

HHCCN:

NOMNC:

ABN:

1.My question is, are we required to complete the NOMNC when the patient, caregiver, or the MD requests discontinuing care abruptly?

If the patientrequests the discharge, the NOMNC is not required to be completed.(Form Instructions 10123-NOMNC cms.gov)

Document clearly in the medical record that the patient or their representative has requested the discharge.

If the physician orders discharge, the clinician should make every attempt to give the patient notice of discharge and get the NOMNC signed within the time prescribed by CMS, unless the patient or their authorized representative requests immediate discharge.

2. Does the time period for delivery of generic notice vary from state to state?

Yes.

Policy 12.0 – Transfer and/or Discharge from Services Home Health

3.3.2 The Agency will deliver the generic notice to the patient (or authorized representative) no less than two days prior to the end of the covered period in Oklahoma, New Mexico, Massachusetts, Connecticut, Kansas, Virginia, Florida, Missouri, Utah, Idaho, Oregon, Maryland, Arizona, Tennessee, Georgia, South Carolina, North Carolina, Alabama, Nevada, Wyoming, Kentucky and Colorado; no less than five days prior to the end of the covered period in Texas, and no less than 10 days in Pennsylvania whenever possible, or as soon as the provider knows that coverage has ended.

3.In dating the NOMNC, can we use “week of”, or does it have to be a specific date?

According to the Form Instructions 10123-NOMNC provided by CMS, it must be a specific date.

4.In the past, we’ve been taught not to use the term “non-compliant” as this might trigger a surveyor to question the appropriateness of home health. Is it ok to use the phrase “non-compliant”?

First, our policy on this subject: Policy 12.0 – Transfer and/or Discharge from Services Home Health:

2.3. Discharge for cause is any situation where the client/family/caregiver’s disruptive, abusive or uncooperative behavior continues after the agency has made and documented serious efforts to resolve the behavior.

Document clearly and objectively why the patient is being discharged and that the patient/CG have been educated on the ramifications of their choices, then deliver and obtain signature on the NOMNC.

5.What if the NOMNC isn’t given and doing so would require scheduling a visit in the next certification period?

Our discharges need to be planned appropriately, including the completion of the NOMNC form for discharge notification in order to avoid a scenario like this. Please refer to your Administrator and RVP if this should occur.

6.If the patient discharges to hospice or outpatient unexpectedly, is the NOMNC still needed?

If the physician orders discharge, the clinician should make every attempt to give the patient notice of discharge and get the NOMNC signed within the time prescribed by CMS, unless the patient or their authorized representative requests immediate discharge. If the patient requests immediate discharge, the NOMNC is not required to be completed. (Form Instructions 10123-NOMNC cms.gov).

7.My patient is being discharged because they have a dog that is dangerous.

We should do everything possible to deliver home care services to our patients as ordered by the physician. However, if you and your supervisor have made every effort to work with the patient and their family to ensure a safe environment for delivery of home care, and the patient is being discharged for business reasons, the NOMNC would not have to be delivered (Form Instructions 10123-NOMNC cms.gov). The HHCCN (Home Health Change of Care Notice) would be delivered and explained, and signature obtained. Option 2: “Your home health agency has decided to stop giving you the home health care listed above” would be the appropriate option.

8.Notice is given one week in advance for the next week by PTA for Thursday discharge (7 days notice). The patient is unable to be seen on Thursday by discharging PT but patient agrees to discharge one day early, on Wednesday. Is this allowable because the patient is in agreement?

Yes. This is acceptable as long as the patient is given the required period of time to exercise their right to appeal as noted in question #2. The Form Instructions 10123-NOMNC (cms.gov) require a specific discharge date. The clinician would strike through the original discharge date (Thursday) and write in Wednesday’s date on both copies, and clinician and patient (or their representative) would sign and date the changes.

9.My question is regarding the HHCCN - I wanted to clarify that this was the correct form to use to notify patients that they will be discharged from the agency if they have not had their F2F by day 30. We were instructed to complete this form at the SOC. Is this the correct time to execute this?

On SOC, if unable to verify F2F encounter date:

1. Attempt to schedule an appointment with the certifying physician, nurse practitioner, or physician assistant within 3 days of SOC as best practice, or ASAP. Notify the appropriate Area Manager
2. Add a Snapshot note that states: “Warning! F2F encounter date not verified. Patient will be discharged on **/**/**** unless F2F encounter verified”.
3. Give patient a completed HHCCN dated 30 days from SOC.
4. Continue follow up with patient at every visit until F2F obtained.

Note the example from the Medicare benefit policy manual in italics:

Example 2 – care termination due to agency reasons (failure to meet face to face encounter requirement)

An HHA has initiated care for a beneficiary, and the beneficiary has not yet had the required face to face encounter with the certifying physician or an allowed non-physician practitioner (NPP). The HHA believes that the face to face encounter requirement will not be met in the allowed time frame and decides to stop providing care.

This termination is due to an HHA administrative decision; thus, the HHCCN must be given to the beneficiary prior to discontinuation of services. Issuing the HHCCN does not affect financial liability but serves as a written change of care notice as required by the HHA COPs

10.As a piggy back to that (#9), why are we using the HHCCN form rather than the ABN form for this?

We use the HHCCN vs. the ABN and choose the second option: “Your home health agency has decided to stop giving you the home care listed above” as this option gives the patient the option to seek care from “a different home health agency”. The ABN (Advance Beneficiary Notice of Non-coverage) is NOT used in this instance, as it is designed to notify the beneficiary of items or services that may not be paid for by Medicare and gives the patient other options that involve payment and billing.

11. If the frequency/duration changes as a result of suggestions made during packet review by the PRQI, do we need to complete an HHCCN?

Yes, if the plan of care changes from what the patient originally agreed to during the SOC or Add-on visit, an HHCCN will need to be completed and signed by the patient, in addition to contacting the physician to confirm agreement. This would also be true when orders are written to decrease visits due to a change in the patient’s status (e.g. when wound status improves and visit frequency is decreased as a result).

12. What are some examples of when a notification is NOT necessary?

From the Medicare guidance manual:

D. Exceptions to HHCCN Notification Requirements

The HHCCN is NOT required when changes in care involve:

• increase in care;

• changes in HHA caregivers or personnel as decided by the HHA;

• changes in expected arrival or departure time for HHA staff as determined by the HHA;

• changes in brand of product, ( i.e., the same item produced by a different manufacturer) as determined by the HHA;

• change in the duration of services that has been included in the POC and communicated to the beneficiary by the HHA, ( i.e., shorter therapy sessions as health status improves, such as a reduction from an hour to 45 minutes);

• lessening the number of items or services in cases where a range of services is included in the POC;

Example: The POC order states: PT 3-5x per week as needed for gait training. The therapist begins therapy at 5 times per week, and as the patient progresses, therapy is reduced to 3 times per week. No HHCCN would be needed in this case.

February 2017