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Home Health Change of Care Notice (HHCCN)

Home health agencies (HHAs) must provide the HHCCN when one of the following triggering events changes the beneficiary's Plan of Care (POC).

  • Reduction – The HHCCN must be issued before care is decreased, such as frequency, amount, or level of care. The HHCCN must list the items/services that are listed on the POC that are being reduced and the reason for the reduction, regardless of who is responsible for paying for that service.

Note: If a reduction occurs for an item or service that will no longer be provided but the beneficiary wants to continue to receive the care and assume the financial charges, an ABN is issued.

  • Termination – The HHCCN must be issued before the discontinuation of all home health care. Reasons for ending home health care include administrative decisions, such as concerns for staff safety, staff shortage, closure of the HHA, or failure to meet face-to-face encounter requirements, or due to physician's orders to discontinue care or a lack of orders to continue care.

Note: The Notice of Medicare Provider Non-Coverage (NOMNC) must be issued to the beneficiary when all Medicare covered services are ending based on the physician's orders. When the NOMNC is issued as required, the HHA does not have to issue a separate HHCCN; however, when care ends because of physician's orders, HHAs have the option of issuing the NOMNC alone or the NOMNC and the HHCCN.

A home health agency can be held liable if the HHCCN is determined to be invalid. Refer to the Invalid ABNs and HHCCNs web page for scenarios of when an HHCCN would be considered invalid.

The HHCCN is not required when changes in care involve:

  • Increase in care;
  • Changes in HHA personnel;
  • Changes in expected arrival or departure times;
  • Change in the duration of services (reduction from an hour to 45 minutes);
  • Lessening the number of items/services where a range of services is included in the POC (PT 3 - 5 x per week);
  • Changes in the mix of services delivered in a specific discipline (skilled nurse discontinues blood draw, but continues other skilled services; same frequency/duration);
  • Changes in the modality affecting supplies used as part of a specific treatment; or
  • Changes in care decided by the beneficiary and documented in the medical record.


Note: Effective July 1, 2019, HHAs must use the renewed form showing the expiration date of 4/30/2022 on the bottom.

Reviewed: 12.08.21


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