Posted by: Robert Markette
September 21, 2006

There has been more information on the HHABN this week. Home Health Lines (HHL) September 18, 2006 issue has two stories related to HHABNs and NAHC has had two separate Q&As responding to members HHABN questions.

In all of this, the biggest piece of news is CMS stating that not only are ranges on HHABNs unacceptable, but that when issuing an HHABN relating to a patient whose POC contains ranges, that the agency must pick a frequency from the range that meets the patients needs.

This response from CMS seems to eliminate another option that has been put forward by NAHC and others stating a minimum number of visits on the HHABN. The theory was that as long as you met the minimum, no reduction occurred and, therefore, no HHABN was necessary. (I always assumed that CMS would eventually rule that option out.)

The discussion by the unnamed CMS staffer, as well as the examples given both require the use of a specific frequency so that when the number of visits reduces, an HHABN would be necessary. This provides a strong indication that a minimum number of visits on the HHABN or in patient communications will be frowned upon by CMS and if you are describing visit frequencies to patients using the minimum visits concept, you should be aware of CMSs position that notice requires a specific frequency.

One of the ways to do meet the specific frequency requirement is by notifying the patient in advance of specific frequencies and predict how the visits will reduce during the plan of care. Then inform the patient of your projection and document that conversation. (This method is discussed in the transmittal.) If you accurately predict the reductions, you will not need to issue an HHABN during the period. Some agencies feel that they can do this accurately, other are not certain. (Obviously, if the reductions occur other than as you predicted, you will need to issue an HHABN.)

The good news is that CMS is trying to find a way around this. The obvious way around this is to allow ranges. As HHL and others have pointed out and as CMS has repeatedly recognized, ranges are completely acceptable on the plan of care. If they are acceptable on the plan of care, there is no reason they should not be acceptable on an HHABN. It is one thing for patients to have notice of changes in their care, but a fluctuation within a clinically acceptable range of visits should not require an HHABN.

A telephone call or other notification to the patient explaining that the POC has not changed, but the frequency of visits has should suffice. The extra effort required to generate and properly deliver an HHABN, when multiplied by the vast number of POCs where the number of visits reduces within an acceptable range of frequencies makes the HHABN unduly burdensome on home health providers.

Of course, CMS is trying to work this issue out while being watched by the Court and Plaintiffs counsel. For now, whether or not CMSs position makes sense does not matter, the point is that CMS expects communications with patients to be in terms of specific frequencies, not ranges. Even though your POC will be in terms of ranges.

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