Home Health Leaders Commend Bipartisan Florida Lawmakers for Urging CMS Against Pre-Claim Review Implementation in Florida

Washington, DC – The Partnership for Quality Home Healthcare — a coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation’s seniors — today applauded bicameral, bipartisan lawmakers from Florida for sending a letter to the Secretary of Health and Human Services Tom Price, MD urging the Centers for Medicare & Medicaid Services (CMS) to stop the implementation of a pre-claim review demonstration (PCRD) in Florida and replace it with targeted program integrity reforms. The bipartisan letter garnered twenty-seven signatures from Members in both the House and Senate.

The letter, led by Senators Bill Nelson (D) and Marco Rubio (R), was also signed by Representatives Gus Bilirakis (R-12), Vern Buchanan (R-16), Kathy Castor (D-14), Charlie Crist (D-13), Carlos Curbelo (R-26), Val Demings (D-10), Ron DeSantis (R-6), Theodore Deutch (D-21), Mario Diaz-Balart (R-25), Neal Dunn, MD (R-2), Alcee Hastings (D-20), Al Lawson (D-5), Brian Mast (R-18), Stephanie Murphy (D-7), Bill Posey (R-8), Francis Rooney (R-19), Thomas Rooney (R-17), Ileana Ros-Lehtinen (R-27), Dennis Ross (R-15), John Rutherford (R-4), Darren Soto (D-9), Debbie Wasserman Schultz (D-23), Daniel Webster (R-11), Frederica Wilson (D-24), and Ted Yoho (R-3).

“We support efforts to combat Medicare fraud and protect taxpayer funds, but we are concerned that the PCRD’s current parameters are too broad to reduce fraud and improper payment rates,” the lawmakers wrote in a letter to Secretary Price. “We encourage you to consider an alternative approach that would achieve these goals and also ease the administrative burden and additional implementation costs for smaller home health agencies, and ensure timely patient access to services.”

PCRD requires that a third-party government contractor authorize reimbursement for physician prescribed home healthcare services. The home health community has warned that this roadblock between a patient and his or her physician will result in care delays and denials at a time when patients are vulnerable. Providers in Illinois, where the PCRD is already underway, have documented difficulty navigating the system and reported numerous delays and denials in care, further underscoring the need to halt the demonstration in Florida where nearly 350,000 people rely on the Medicare home health benefit.

The Partnership, in a letter to Secretary Price issued last month, asked the Department of Health and Human Services to discontinue PCRD before April 1 when it is scheduled to be expanded into Florida. The Partnership letter raises concerns that the PCRD is an onerous process requiring 100 percent review of 100 percent of claims relating to eligibility criteria, and was implemented without a formal rulemaking process.

“Imposing the complex requirement of obtaining documentation that is generally within the physician’s medical record and applying a subjective determination of its accuracy puts the government directly between patients and their physicians and home health providers and have resulted in significant costs to everyone involved, including CMS,” the Partnership letter states.