[Federal Register Volume 65, Number 195 (Friday, October 6, 2000)]
[Notices]
[Pages 59858-59859]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-25936]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifiers: HCFA-R-296 (OMB # 0938-0781)]


Notice of Extension of Emergency Office of Management and Budget 
Clearance of Agency Information Collection Activities

AGENCY: Health Care Financing Administration, DHHS.
    The Health Care Financing Administration (HCFA), Department of 
Health and Human Services, is publishing this Notice to inform the 
public that the Office of Management and Budget (OMB) has approved our 
request for an extension of the OMB clearance on model advance 
beneficiary notices (ABNs), for which we first requested emergency 
clearance by Federal Register notice dated September 22, 1999 (HCFA-R-
296, OMB # 0938-0781). Clearance of these model ABNs (referred to as 
HHABNs) for use by home health agencies (HHAs) has been extended 
through January 31, 2001. These model notices, together with the 
instructions in Program Memorandum Transmittals A-99-52 and A-99-54, 
remain in effect following the implementation of the prospective 
payment system (PPS) for home health agencies on October 1, 2000. HCFA 
also has published a Federal Register notice on September 26, 2000, 65 
FR 57821, seeking emergency OMB clearance, pursuant to the Paperwork 
Reduction Act, of a revised uniform Home Health Advance Beneficiary 
Notice (HHABN), which we expect to make mandatory in January 2001.
    Use: The purpose of this Notice is to clarify, for Medicare 
beneficiaries, for HHAs, and for other interested members of the public 
that existing requirements regarding notice and demand bills, as set 
forth in Program Memorandum Transmittals A-99-52 and A-99-54, and as 
reflected in the model notices for which OMB has extended the emergency 
clearance, remain in effect following the implementation of the 
prospective payment system for HHAs on October 1, 2000. Thus, in 
accordance with the instructions in PMs A-99-52 and A-99-54, HHAs 
continue to be responsible for providing proper ABNs and for submitting 
demand bills to Regional Home Health Intermediaries (RHHIs) when 
requested to do so by a beneficiary or by a person acting on the 
beneficiary's behalf. Moreover, the transition to PPS does not change 
HHAs' responsibility to follow ABN and demand bill procedures for plans 
of care in which the physician's order spans the transition.
    HHAs must give a Medicare beneficiary a proper ABN before reducing 
or terminating home health care the beneficiary already is receiving, 
if the physician's order for such care would still continue the care, 
and an HHA believes that the services do not meet Medicare coverage 
criteria. In instances where care has not yet been initiated and an HHA 
believes services ordered by the physician do not meet Medicare 
coverage criteria, it must also provide a proper ABN. Currently, HHAs 
may use the model HHABNs designed by HCFA (Form No. HCFA-R-0296) or 
forms of the HHA's own design to meet the beneficiary notification 
requirement.

Continued Use of Demand Billing Procedures and Meaning of ``Prompt'' 
Submission Under HHA PPS

    With respect to the instructions regarding demand bills in 
Transmittals A-99-52 and A-99-54, we want to emphasize that the demand 
bill process remains in effect following the implementation of HHA PPS, 
and must be used by HHAs to ensure continuation of beneficiary rights 
to obtain an official Medicare initial determination. Beginning in 
June, HCFA has been assessing the operational feasibility and impact of 
options for integrating the initial determination process into HHA PPS. 
In the HHA PPS final rule published on July 3, 2000, we stated, in 
response to public comment, that HCFA was reviewing demand billing 
procedures to determine whether they must be modified to account for 
the differences between HHA reasonable cost billing and HHA PPS. 65 FR 
41128, 41169 (July 3, 2000) (Medicare Program; Prospective Payment 
System for Home Health Agencies, Final Rule). As a result of our 
assessment of the feasibility of various options, HCFA decided to 
continue to use the demand bill process as the mechanism by which 
Medicare beneficiaries obtain an official Medicare initial 
determination when an HHA believes, under HHA PPS, that Medicare will 
not, or will no longer, cover services ordered by a physician.
    When a beneficiary agrees to be fully and personally responsible 
for payment for the services if Medicare decides the services are not 
covered, and has requested that a claim be submitted to Medicare, HHAs 
must ``promptly'' submit a claim to the RHHI and report, on the claim 
submitted, condition code 20 (demand-beneficiary requested billing) to 
indicate the beneficiary believes the services are covered (see PM A-
99-52 sec. I-2A). Under HHA PPS, HHAs may submit only one claim for 
payment at the end of each episode of care. See 65 FR at 41141. Thus, 
under HHA PPS, ``prompt submission'' of a claim with the demand bill 
code requires that the claim (i.e., the demand bill) be submitted at 
the end of the episode in question, at the same time the claim for 
final payment for the episode is submitted. Pursuant to the HHA PPS 
Final Rule, where an HHA has received a ``request for anticipated 
payment'' (RAP) for an episode, the RAP will be canceled and recovered 
unless the claim for the episode (with the condition code 20 to 
indicate that the claim is a demand bill when requested by the 
beneficiary in the circumstances described in PM A-99-52) is submitted 
within the greater of 60 days from the end of the episode or 60 days 
from the issuance of the anticipated payment. 65 FR at 41141.

Future Plans

    As noted above, on September 26, 2000, HCFA published a Federal

[[Page 59859]]

Register notice seeking emergency OMB clearance, pursuant to the 
Paperwork Reduction Act, of a revised uniform mandatory Home Health 
Advance Beneficiary Notice (HHABN). (The Federal Register notice, which 
includes procedures for submitting comments on the revised HHABN, the 
revised uniform HHABN and related documents, including a Supporting 
Statement, are posted on HCFA's website at http://www.hcfa.gov/regs/prdact95htm, and are also available via an e-mail request sent to 
<a href="/cdn-cgi/l/email-protection#6e3e0f1e0b1c19011c052e060d080f40090118"><span class="__cf_email__" data-cfemail="cb9baabbaeb9bca4b9a08ba3a8adaae5aca4bd">[email protected]</span></a>). HCFA has requested that OMB issue an emergency 
clearance of the proposed uniform HHABN by October 12, 2000, and HCFA 
intends to make mandatory the use of the HHABN not later than 90 days 
following OMB approval. (See the Supporting Statement for HCFA-R-0296). 
The instructions and requirements of PMs A-99-52 and A-99-54 will 
remain in effect until a further instruction with a new mandatory 
implementation date is issued. HCFA expects to issue these instructions 
as soon as it receives emergency approval by the Office of Management 
and Budget (OMB). HCFA strongly advises that HHAs use the new notice 
(the HHABN) once it is approved and instructions are issued, rather 
than waiting until its use becomes mandatory in January 2001.

    Dated: October 4, 2000.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA, Office of Information Services 
Security and Standards Group Division of HCFA Enterprise Standards.
[FR Doc. 00-25936 Filed 10-6-00; 8:45 am]
BILLING CODE 4120-03-P


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