Where can I find information regarding home health patients transitioning from and/or to HMOs?

Answer:
Information regarding Medicare patients whose status with a Medicare Advantage (MA) plan (also known as a Medicare HMO plan) changes within an episode of care may be found in the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 10, Section 80. This section of the manual also contains information regarding the OASIS requirements for Medicare patients who opt to enroll or disenroll from the MA plan during an episode of care. For additional questions or concerns regarding the OASIS requirements, providers may contact their state OASIS Education Coordinator. The
CMS OASIS Educational Coordinators document (PDF, 79 KB) contains the contact information for the state OASIS education coordinators.

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