Home Health Leaders Thank Bipartisan Lawmakers for Opposing Medicare Home Health Prior Authorization Requirement

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 – commended a bipartisan group of 116 lawmakers in the U.S. House of Representatives, led by Congressmen Tom Price (R-GA) and Jim McGovern (D-MA), for sending a letter to Department of Health and Human Services’ (HHS) Secretary Burwell and Centers for Medicare & Medicaid Services’ (CMS) Acting Administrator Slavitt urging withdrawal of the proposed demonstration for prior authorization of Medicare home health services.

The bipartisan lawmakers write, “This demonstration project imposes costs on patients, providers and taxpayers. Delaying patient care while waiting for CMS to approve home health services may put patient health in jeopardy and cause patients to stay in the hospital longer than necessary.”

The House letter echoes deep concerns expressed by the Partnership and stakeholders throughout the entire home health community, including unwarranted disruptions in patient care that will put one of Medicare’s oldest and frailest populations at risk.

Specifically, lawmakers and home health community members are most concerned about the impact on patient access to timely, necessary home healthcare. Prior authorization would require CMS to review physician ordered healthcare before a patient can receive services, causing care delays for countless Medicare beneficiaries at a time when they are most vulnerable. Facing delays during the critical hospital to home transition has the potential result in adverse events, which jeopardize patient health and lead to costly hospital readmissions.

“Many patients find themselves in the most clinically fragile condition during the week following a hospital discharge. It is vitally important that we continue to meet the care needs of Medicare patients during this critical transition time post-hospital discharge,” the lawmakers wrote.

Additionally, a goal of the demonstration is to prevent fraud and abuse within home healthcare. However, instead of targeting bad actors, lawmakers warn this proposal will instead increase the administrative burden on home health agencies with no track record of fraud while doing little to identify fraudulent and abusive behaviors.

Finally, lawmakers caution there is no legal authority to impose prior authorization for Medicare home health. The authority cited in the rule states the Secretary of HHS has the authority to develop improved methods to investigate and prosecute fraud, however the proposed prior authorization requirement is a method of screening and utilization management, not an effective process for preventing fraud.

“We recognize the intent of the proposal is to combat fraud and abuse within the home healthcare community, but instead of penalizing patients, taxpayers and providers, we ask that CMS work with us to develop program integrity solutions that are patient centered and eliminate bad actors without disrupting access to care and increasing healthcare costs,” stated Keith Myers, Chairman of the Partnership for Quality Home Healthcare. “For this reason, we commend Congressmen Price and McGovern and their bipartisan colleagues for urging CMS to withdraw the prior authorization demonstration and protect timely access to clinically advanced, cost effective and patient preferred home health services for Medicare’s most vulnerable seniors.”

To view the house letter, click here.