Legislators Lobby CMS to Withdraw Home Health Restriction

Added on Jun 16, 2016

Legislators Lobby CMS to Withdraw Home Health Restriction
From Industry Edge June 2016

In a letter sent to U.S. Department of Health & Human Services (HHS) Secretary Sylvia Mathews Burwell and acting Centers for Medicare & Medicaid Services (CMS) Administrator Andrew Slavitt, more than 100 members of the U.S. House of Representatives have lobbied HHS to withdraw its plans for a demonstration project that would require prior authorization for home health care services.

Under the planned project, home health care companies in five states (Michigan, Illinois, Florida, Massachusetts and Texas) that provide services without prior authorization would receive an immediate penalty of 25% of their payment, even if the services are considered appropriate and necessary to the patient. The proposed project was introduced in response to concerns of widespread fraud in the Medicare program related to home health care services and durable medical equipment.

The letter from the legislators contends that prior authorization would interfere with the patient-physician relationship and ultimately limit access to home health care services. The lawmakers suggested the department take a more focused approach to target and penalize fraudulent behavior of “bad actors,” rather than placing a significant burden on all parties.

“We are concerned that a demonstration project centered on prior approval or ‘prior authorization’ of home healthcare would interfere with the patient-doctor relationship and is in conflict with the policy goal of moving toward patient-centered care,” the bipartisan group of legislators wrote. “Stated simply, prior authorization of home health care imposes a requirement that prevents a patient from receiving home health services after the physician orders home health care unless and until an intermediary has reviewed and approved the order.”

Delaying patient care while waiting for authorization “may put patient health in jeopardy and cause patients to stay in the hospital longer than necessary,” the legislators stated. As such, they asked that the proposal be withdrawn to avoid “unnecessary restrictions on patient access to home health services.”