Lawmakers Take Stand Against Home Health Prior Authorization

Mounting backlash against the Centers for Medicare & Medicaid Services’ (CMS) proposed home health preauthorization rule is coming from a fresh source—lawmakers on both sides of the aisle.

A bipartisan group of 116 lawmakers in the U.S. House of Representatives penned a letter to CMS Acting Administrator Andrew Slavitt and Department of Health and Human Services (HHS) Secretary Sylvia Burwell requesting the withdrawal of the proposed demonstration for prior authorization of Medicare home health services.

The proposal, made by CMS in February with the aim of cracking down on Medicare fraud and abuse, would require home health agencies to receive prior authorization before caring for patients.

Delaying patient care while waiting for CMS to approve home health services would jeopardize patient health and result in patients remaining in the hospital longer than necessary, the lawmakers said in the letter.

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

Additionally, the proposal would not target bad actors as planned, the lawmakers argued. Instead, the proposal would do little to identify abusive and fraudulent behavior, while increasing the administrative burden on all home health agencies—even those that do not have a history of fraud.

The lawmakers also attacked the legality of the preauthorization rule, saying the government has no legal authority to impose prior authorization for Medicare home health.

The Partnership for Quality Home Healthcare, a Washington, D.C.-based coalition of home health providers whose mission is to improve the integrity, efficiency and quality of home health care for seniors nationwide, commended the lawmakers for their letter.

“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,” Partnership for Quality Home Healthcare Chairman Keith Myers said in a prepared statement.

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