Home Health & Hospice

HHABN Can Help in Difficult Situations

Homecare Insider, February 9, 2009

When the Centers for Medicare & Medicaid Services (CMS) implemented the revised Home Health Advance Beneficiary Notice (HHABN) in 2005, there was some grumbling.  Instead of one notice, there were now three.  So much for paperwork reduction.  However, one of these notices can be very valuable in some situations that can be difficult to handle.  Consider this question.  

The physician has ordered skilled nursing twice a week and daily home health aide visits for a bedbound, incontinent patient.  She definitely qualifies for Medicare coverage but this is not a good situation.  She is verbally abusive.  Her son is often intoxicated when my staff visit.  The patient has a huge dog that growls at some home health aides.  She’s quite influential in the community so I don’t want to make problems for the agency.  However, I have to beg and barter for staff to visit her and even with that, I can’t guarantee we’ll cover all the visits.

An agency can choose to discharge a patient for its own administrative reasons if it is unable to meet the patient’s needs.  In this case, the patient is making it difficult for the agency to provide care.  The environment is not conducive to caregiving and probably not safe for these caregivers.

After discussion with staff and the physician, this administrator can issue HHABN Option Box 2.  It notifies the patient that the agency can no longer provide care and that she is free to seek care from another homecare agency.  If no one is willing to return to the home to give the patient this notice, the administrator can call the patient to explain the situation and then send two copies of the notice to the patient.  Hopefully, the patient will sign and return one to the agency.  If this doesn’t happen, the administrator should make a follow-up call or two and document her efforts to obtain the signature.  This administrator must also check for any applicable state licensure regulations about discharge and abide by them.

HHABN and Expedited Review: Managing the Processes for Homecare Providers can help staff understand the HHABN and use it appropriately for patient notification.  Learn more from this educational manual published by Beacon Health at — click here.