Posted by: Robert Markette
August 17, 2006

Well, after a great deal of waiting, we finally saw the Program Transmittal relating to the HHABN.  It appears to include everything from both Q&As as well as additional details.  Having just participated in two seperate HHABN seminars, I wish CMS would have issued this transmittal a week or two ago.  The transmittal tries very hard to calrify when an HHABN is appropriate, and even contains a number of charts that break down the need for an HHABN by whether the care is covered, if it is in the home health benefit, and which notification provisions apply.  This is far more detail than any of the previous documents CMS has issued.  This illustrates the problematic nature of this whole process.  More than five months into this "process" and with only a couple of weeks until the compliance deadline, we get the detailed instructions.

A couple of things jumped out at me as I read through the transmittal.  (Yes, I actually read it.)  First, CMS says you cannot use ranges in an HHABN. This is a major change, because all previous indications were that reasonable ranges would be acceptable.  CMS cautiioned providers on the use of broad ranges, but there was never any indication that ranges were not acceptable.  Apparently, CMS has decided they are.  Therefore, the use of ranges to avoid issuing HHABNs is not an option.  The HHABN will need to state specific frequencies and when reductions occur, HHABNs may be necessary.

Also, preplanned reductions, an exception in the original instructions, are clarified in this transmittal.  The preplanned reductions exception now requires the reduction be part of the initial POC and communicated to the beneficiary.  Reading further into the transmittal leads to the conclusion that CMS intends for this communication with the beneficiary to be through an HHABN.  CMS says that if an agency is comfortable with it, the agency may provide advance notice of all triggering events to the beneficiary. (Be sure not to use ranges when doing this, even if ther are in the POC.)

 This advance notice would then eliminate the need for HHABN's upon the occurrence of the triggering events as outlined in the original HHABN.  However, if any triggering events occurred during the period that were not outlined in the original HHABN, a new HHABN would need to be issued.  In my opinion, this means if you want to rely upon the "preplanned reductions" exception, you would have to issue an HHABN upon initation of covered care.  Of course, this eliminates the need to issue HHABNs for preplanned reductions, but does undermine the "no HHABN upon initiation of covered care" rule.

 Once again, I think the transmittal answers some questions, but I beleive it will leave beneficiaries with more questions.  That is not unusual with any new regulatory requirement, as every provider is afraid of doing something wrong and with anything new like this, that fear is greater.  But like every other new regulatory requirement, the new HHABN shall become familiar to you in no time at all.

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