Lawmakers Urge CMS to Kill Home Health Care Demo

Over 100 House members are urging the Obama administration to withdraw a demonstration program that would require prior authorization before processing claims for home healthcare in an effort to prevent fraud.

The lawmakers say the proposal would interfere with the patient-doctor relationship and would undermine efforts to move towards patient-centered care. The bipartisan letter was led by Reps. Tom Price (R-Ga.) and Jim McGovern (D-Mass.), and was signed by 116 lawmakers.

“Stated simply, prior authorization of home healthcare imposes a requirement that prevents a patient from receiving home health services after the physician orders home healthcare unless and until an intermediary has reviewed and approved the order,” they write.

The demo occur in Florida, Texas, Illinois, Michigan and Massachusetts. CMS hopes the program will stop the improper payment rate for Home Health Agency to stop increasing.

The lawmakers say the demo would limit access to home care, increasing the length and cost of hospital stays for patients, and raised concerns that the demo could cost taxpayers more than a quarter of a billion dollars. They also say that CMS is overstepping its authority by testing a “method of screening and utilization management, not a method for investigation or prosecution of fraud.”

“This demonstration project imposes costs on patients, providers and taxpayers,” they write. “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 for longer than necessary.”

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