[Federal Register Volume 65, Number 1 (Monday, January 3, 2000)]
[Notices]
[Pages 135-136]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-33945]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

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


Agency Information Collection Activities: Proposed Collection; 
Comment Request

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. The proposed collections consist of uniform mandatory notices 
to be given to Medicare home health beneficiaries by home health 
agencies (HHAs) when the HHA believes that services may not or may no 
longer be covered. Interested persons are invited to send comments 
regarding burden or any other aspect of these collections of 
information requirements. All comments will be considered together, 
including those comments submitted with respect to the Emergency 
Federal Register notice published on September 22, 1999, with regard to 
balancing the burden on providers with the provision of sufficient 
information to beneficiaries. We are particularly interested in 
receiving input regarding the form of the notices and the order in 
which the information is presented. We also invite comments on how best 
to fully inform beneficiaries with regard to services not covered by 
Medicare. Comments may also be sent regarding 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.
    Additionally, we acknowledge that comments regarding these notices 
were made by beneficiary advocates in the context of the ongoing 
litigation in Healey v. Shalala, Civil Action No.3:98CV00418 (DJS) 
(D.Conn.). These comments related to: (1) the extent and type of notice 
that is required in cases in which the physician concurs in the 
reduction, termination, or denial of services; (2) the incorporation of 
a statement regarding a requirement that a beneficiary agree to share 
her medical records with the RHHI in the event that she requests the 
submission of a demand bill; and (3) general concerns about design and 
readability. The comments will be considered along with all other 
comments received in response to this request. However, we consider it 
most efficient and effective to publish these notices for comment in 
their present form and to consider all comments in a single 
comprehensive proceeding.
    We also received comments from the National Association of Home 
Care (``NAHC'') , representing members of the provider community, 
regarding these notices. These comments related to the time required 
for implementation and general readability concerns. Among other 
things, NAHC also stated its belief that the notices misstate, in the 
boxes regarding the beneficiaries' choices, the standard under which 
coverage is determined. Similarly, these concerns will be considered 
with all other comments received in response to this request.
    Type of Information Collection Request: Extension of a currently 
approved collection;
    Title of Information Collection: Home Health Advance Beneficiary 
Notices (HHABNs) and Supporting Regulations in 42 CFR Section 
411.404-.406, 484.10, and 484.12(a);
    Form No.: HCFA-R-0296 (OMB# 0938-0781);
    Use: Beneficiaries must 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

[[Page 136]]

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 these reasons, uniform 
mandatory notices (the HHABNs) with very specific content and graphic 
design have been prepared (they are attached as Exhibits 1-3 hereto), 
which are to be used by all HHAs furnishing services to Medicare 
beneficiaries.
    When an 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. The attached 
HHABNs are designed to ensure that 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. The HHABNs are to 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 are to be 
provided by HHAs 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 would 
be 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.
    Home Health Advance Beneficiary Notices (HHABNs) HHABNs, Exhibits 
1-3 serve as notice to the beneficiary that the HHA believes that home 
health services are not, or will no longer be, covered in different 
situations. HHABN-T, Termination, is used when all home health services 
will be terminated. HHABN-I, Initiation, is used when the HHA expects 
that Medicare will not pay, even before services have been initiated. 
HHABN-R, 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).
    Frequency: On occasion.
    Affected Public: Individuals or Households, Business or other for-
profit, Not-for-profit institutions.
    Number of Respondents: 540,000.
    Total Annual Responses: 1,080,000.
    Total Annual Hours: 180,000.
    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, OMB number, and 
HCFA document identifier, to P[email protected], or call the Reports 
Clearance Office on (410) 786-1326. Written comments and 
recommendations for the proposed information collections must be mailed 
within 60 days of this notice directly to the HCFA Paperwork Clearance 
Officer designated at the following address: 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.

    Dated: December 22, 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. 99-33945 Filed 12-30-99; 8:45 am]
BILLING CODE 4120-03-P