[Federal Register Volume 64, Number 183 (Wednesday, September 22, 1999)]
[Notices]
[Pages 51328-51330]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-24845]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-R-0296]


Emergency Clearance: Public Information Collection Requirements 
Submitted to the Office of Management and Budget (OMB)

AGENCY: Health Care Financing Administration, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), Department of Health and Human Services, is 
publishing the following summary of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
burden estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the agency's functions; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    We are, however, requesting an emergency review of the Information 
collections referenced below. In compliance with the requirement of 
section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, we have 
submitted to the Office of Management and Budget (OMB) the following 
requirements for emergency review. We

[[Page 51329]]

are requesting an emergency review because the collection of this 
information is needed prior to the expiration of the normal time limits 
under OMB's regulations at 5 CFR, part 1320. The Agency cannot 
reasonably comply with the normal clearance procedures because public 
harm is likely to result because beneficiaries may not receive timely, 
accurate, complete, and useful notices which will enable them to make 
informed consumer decisions, with a proper understanding of their 
rights to a Medicare initial determination, their appeal rights in the 
case of payment denial, and how these rights are waived if they refuse 
to allow their medical information to be sent to Medicare. This 
information collection standardizes the requirements set forth under 42 
CFR 484.10, currently approved under OMB number 0938-0365.
    HCFA is requesting OMB review and approval of this collection by 
close of business 09/30/1999, with a 180-day approval period. Written 
comments and recommendations will be accepted from the public if 
received by the individuals designated below by close of business 9/29/
1999. During this 180-day period, we will publish a separate Federal 
Register notice announcing the initiation of an extensive 60-day agency 
review and public comment period on these requirements. We will submit 
the requirements for OMB review and an extension of this emergency 
approval.
    Type of Information Collection Request: New Collection;
    Title of Information Collection: Home Health Advance Beneficiary 
Notices (HHABNs) and Supporting Regulations in 42 CFR 484.10;
    Form No.: HCFA-R-0296 (OMB
#0938-NEW);
    Use: This program memorandum (PM) is intended to instruct Home 
Health Agencies (HHAs) with respect to their responsibility for 
providing proper written notice to beneficiaries in advance of 
furnishing what they believe to be noncovered care or of reducing or 
terminating ongoing care. These new instructions and notices apply 
where a physician has ordered home health care for a beneficiary but 
the HHA believes that Medicare will not pay for that care. They do not 
apply to situations where the physician will not order care, or where 
care is reduced or terminated in accordance with a physician's order. 
Medicare never pays for home health care that is not ordered by a 
physician. The instructions in the PM supersede current instructions in 
Medicare Intermediary Manual, Part 3 (MIM) Sec. 3730.2 and in Home 
Health Agency Manual Sec. 270. These new instructions are designed to 
ensure that beneficiaries receive timely, accurate, complete, and 
useful notices which will enable them to make informed consumer 
decisions, with a proper understanding of their rights to a Medicare 
initial determination, their appeal rights in the case of payment 
denial, and how these rights are waived if they refuse to allow their 
medical information to be sent to Medicare. It is essential that such 
notice be timely, readable and comprehensible, provide clear 
directions, and provide accurate and complete information about the 
services affected and the reason that Medicare denial of payment for 
those services is expected by the HHA. For this reason, new notices 
(the HHABNs) with very specific content and graphic design have been 
prepared and are attached as Exhibits 2-4 hereto, and must be used by 
all HHAs furnishing services to Medicare beneficiaries.
    The model notices attached to the memorandum are designed to ensure 
HHAs inform beneficiaries in writing, in a timely fashion, about 
changes to their home health care, the fact that they may have to pay 
for care themselves if Medicare does not pay, the process they must 
follow in order to obtain an initial determination by Medicare and, if 
payment is denied, to file an appeal, and the fact that they waive 
those rights if they refuse to allow their medical information to be 
sent to Medicare. If the HHA expects payment for the home health 
services to be denied by Medicare, a beneficiary must be advised before 
home health care is initiated or continued, that in the HHA's opinion, 
payment probably will be required from him or her personally. These 
notices must be issued by the HHA each time, and as soon as the HHA 
makes the assessment that it believes Medicare payment will not be 
made. The HHABNs must be provided by HHAs according to these 
instructions in any case where a reduction or termination of services 
is to occur, or where services are to be denied before being initiated, 
except in any case in which a physician concurs in the reduction, 
termination, or denial of services. Failure to do so is a violation of 
the HHA Conditions of Participation in the Medicare Program, which are 
currently approved PRA requirements approved under OMB number 0938-
0365, and may result in the HHA being held liable under the Limitation 
on Liability (LOL) provision.
    These instructions for completion, provision, and effectuation of 
advance beneficiary notices by HHAs are to be used by RHHIs effective 
September 30, 1999. The model notices (HHABNs) must be used by 
providers and as required by the MIM, Part 3, Sec. 3440 Establishing 
When Beneficiary is on Notice of Noncoverage.
    Completion of Model Home Health Advance Beneficiary Notices 
(HHABNs) Model Notice Exhibit 1 of the PM is for instructional purposes 
only and includes guidance on the notice form. Model HHABNs, Exhibits 
2-4, serve as notice to the beneficiary that the HHA believes that home 
health services are not covered in different situations. HHABN-1, 
Termination, is used when all home health services will be terminated. 
HHABN-2, Initiation, is used when the HHA expects that Medicare will 
not pay, even before services have been initiated. HHABN-3, Reduction, 
is used when ongoing home health services will be reduced (e.g., 
reduced in number, frequency, or for a particular subset of services, 
or otherwise). For any particular HHABN, the provider makes an original 
and two copies. (If you require a copy, one more will be made.) The 
provider gives, or where this is not possible mails, the original to 
the beneficiary (or the person acting on his or her behalf), sends the 
first copy to the beneficiary's physician, and keeps the second. When 
the beneficiary (or person acting on his or her behalf) is given a 
copy, he or she will return it to the provider with his or her 
signature and the date he or she signed the notice. If the beneficiary 
or the person acting on behalf of the beneficiary refused to sign the 
HHABN, the provider's copy should be annotated accordingly, indicating 
the circumstances and persons involved;
    Frequency: On occasion;
    Affected Public: Individuals or Households, Business or other for-
profit, Not-for-profit institutions;
    Number of Respondents: 188,326;
    Total Annual Responses: 360,000;
    Total Annual Hours: 60,000.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access HCFA's 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail 
your request, including your address, phone number, to 
P[email protected], or call the Reports Clearance Office on (410) 786-
1326.
    Interested persons are invited to send comments regarding the 
burden or any other aspect of these collections of Information 
requirements. However, as noted above, comments on these Information 
collection and recordkeeping requirements must be mailed and/or faxed 
to the designees referenced below, by close of business 09/29/1999:


[[Page 51330]]


Health Care Financing Administration, Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards, 
Attention: Dawn Willinghan, Room N2-14-26, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.
      and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Fax Number: (202) 395-6974 or (202) 395-5167, Attn: Allison 
Herron Eydt, HCFA Desk Officer.

    Dated: September 20, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-24845 Filed 9-20-99; 2:40 pm]
BILLING CODE 4120-03-P