September 14, 2016

Partnership Commends Florida Senators Nelson and Rubio for Urging CMS to Delay Pre-Claim Review Demonstration for Home Health

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Washington, D.C. — 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 — has applauded U.S. Senators Bill Nelson (D-FL) and Marco Rubio (R-FL) for sending a letter to the Centers for Medicare & Medicaid Services’ (CMS) Acting Administrator Andy Slavitt this month, expressing concern with CMS’ pre-claim review demonstration (PCRD) for home health services and urging CMS to delay the expansion of PCRD into Florida, which could take effect as early as October 1.

“We remain concerned this documentation may restrict beneficiary access to timely services, divert clinical resources to paperwork management, and incur high administrative costs,” the Senators wrote in a letter to CMS. “We urge CMS to delay expansion of PCRD into Florida and the other states until CMS, stakeholders, and Congress have the opportunity to evaluate and understand the impact of the demonstration in Illinois.”

CMS’ pre-claim review demonstration took effect across the state of Illinois on August 3 and is scheduled to affect seniors in four more states over three years – including Florida – with the potential for national application. The PCRD requires a third party contractor – known as a MAC – to review and approve claims for physician ordered home healthcare before Medicare will provide reimbursement for patient services. Home health leaders have warned that pre-claim review policies will lead to higher Medicare and patient costs, as patients who would otherwise be served in their home may be referred to higher cost settings.

“Since the PCRD took effect in Illinois on August 3, we have heard troubling reports from the field indicating that Medicare contractors are unprepared to manage the increased workload, which has resulted in both claim denials and delays in physician-prescribed patient care,” said Colin Roskey, Executive Vice President of the Partnership. “We commend Senators Nelson and Rubio for their leadership on this issue and hope CMS will strongly consider their concerns and delay expansion of this demonstration in other states until CMS can study and understand the impacts on patient care and identify more targeted methods for reducing improper payments.”

While pre-claim review was put in place to reduce improper payments for Medicare home health, home health leaders have warned that it will not appropriately prevent fraud and abuse. Instead, the Partnership advocates for more targeted policy reforms that identify and eliminate bad actors from the Medicare program.

Added Roskey, “We will continue to track and evaluate the impacts of the pre-claim review demonstration in Illinois and share these with CMS and lawmakers so that we can work together to identify problems and develop policy solutions that strengthen the delivery of home healthcare and the integrity of the Medicare benefit without jeopardizing patient care.”