Posted by: Robert Markette
May 12, 2006

A reader e-mailed me with a question yesterday. (yes, not only are people reading the home care law blog, but some are actually taking time out of their busy day to ask questions.) Ok, really it has only been the one reader, but because she was diligent enough to ask, I will attempt to answer her question. I say attempt, because I am trying to determine CMSs intent from a couple of Q&A entries and statements made at meetings.

The question is this, for providers who provide telehealth services to their beneficiaries, does an HHABN have to be issued. If so when does the HHABN have to be issued.

Telehealth, as a noncovered service, would appear to be subject to the revised rule requiring home health agencies to issue an HHABN upon initiation of the non-covered care, but not upon reduction or termination. However, the recent FAQ addressed this issue in a somewhat confusing fashion.

Telehealth was addressed in the most recent FAQ in the context of telemonitoring. An agency provides its Medicare patients with telemonitoring services free of charge, because of the improvement to the quality of care that results. The telemonitoring services are included on the plan of care after consulting with the physician. The agency asked CMS if an HHABN was needed for this service.

CMS responded that even though the telemonitoring is a non-covered service, when it is integrated with Medicare covered services or when it is being provided to a Medicare beneficiary receiving non-covered services with no other insurance coverage, an HHABN should be issued. CMS added that written notice is required upon reduction or termination as well.

Of course, this answer appears to conflict with the answers provided elsewhere in the FAQ. Specifically, elsewhere CMS makes it clear that when reducing or terminating non-covered care (unless the patient has no insurance at all) an HHABN is unnecessary.

In my opinion, when you are providing non-covered telemonitoring to a patient who is not receiving other covered care, except for beneficiaries who have no other insurance, you will only need to issue the HHABN upon initiation of the telemonitoring service. You will not need to issue an HHABN a reduction or termination of the non-covered telemonitoring services. (If the Medicare beneficiary is receiving non-covered care, but has no other insurance, you would issue an HHABN for initiation, reductions or terminations see the most recent FAQ for more on that.)

However, when the services are integrated into a POC with covered services, the rule is slightly different. In this case, the telemonitoring is provided because of the covered services. Even though the telemonitoring is not covered, the beneficiary is receiving covered care and the telemonitoring is listed on the POC with the rest of the covered care. In this case, the beneficiary would not receive an HHABN upon initiation, but would receive one upon reduction or termination of the telemonitoring.

Practically, it seems that the agencies offering telemonitoring for free would only reduce or terminate the telemonitoring if the covered care was reduced. In which case, an HHABN or ED is being issued regardless, because you are reducing or terminating covered care.

When issuing an HHABN for non-covered telemonitoring care, if you are not charging the patient, you would list the cost as $0 in Option Box 1. If you are charging the patient, you would, of course, list the costs and fees associated with the telemonitoring service. As I understand it, this will usually be an installation fee and a subscription or monitoring fee. Of course, if you are terminating because it is no longer financially feasible, you should use option box 2.

Of course, I am sure that this answer will change in the coming weeks as CMS continues to reconsider how the HHABN should be used.

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