Partnership for Quality Home Healthcare commends CMS for stopping pre-claim review demonstration

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 — today commended the Centers for Medicare & Medicaid Services (CMS) for stopping the planned implementation of a Pre-Claim Review Demonstration (PCRD) in Florida, which would have applied new, mandatory regulatory requirements on all home health agencies (HHAs) operating across the state on April 1. The Partnership also praised CMS for pausing the application of the demonstration program in Illinois for at least 30 days, where it was originally implemented in August 2016.

Under the new demonstration, home health providers would be required to gain approval of physician ordered services from a non-clinical third party government contractor to ensure Medicare payment for delivered care services. Across Illinois, providers have documented difficulty navigating the system and reported numerous delays and denials in care for Medicare seniors. Inserting a middleman between a doctor and his or her patient only creates roadblocks to care, such as care delays or denials at a time when patients are most vulnerable.

"We are incredibly pleased CMS listened to the concerns expressed by bipartisan lawmakers and home health stakeholders, and suspended the application of the demonstration," stated Keith Myers, Chairman for the Partnership for Quality Home Healthcare. "While the Partnership fully supports CMS' intent to reduce waste, fraud and abuse within the Medicare home health benefit, the pre-claim review demonstration is not the right approach and we are grateful CMS has chosen to suspend the program while improvements are made, which we believe will be beneficial to providers, physicians and patients alike."

The decision to halt the demonstration will allow CMS, the home health community and other stakeholders to work collaboratively to strengthen the program with policy alternatives and through proper education and training. Further, home health leaders are asking CMS to work with them to develop alternative, targeted reforms to reducing fraud and abuse without disrupting the care of vulnerable Medicare patients.

"I applaud the home health community for working collectively to alert CMS of our concerns to ensure home health policies are reformed to enable the delivery of quality and timely healthcare to the older Americans and individuals living with disability we serve daily," added Myers.

Currently, 3.5 million Americans nationwide receive the Medicare home health benefit, which is widely regarded as clinically advanced, cost effective and patient preferred.