Deadline Extended on House Letter to CMS Opposing Prior Authorization Proposal
Tuesday, May 24, is the Deadline for Representatives to Sign the Letter
May 23, 2016 11:31 AM
The National Association for Home Care & Hospice (NAHC) is asking everyone to contact their members of the U.S. House of Representatives to request that they cosign the letter being circulated by Congressmen Tom Price (R-GA-6) and James P. McGovern (D-MA-2) urging the Centers for Medicare & Medicaid Services (CMS) to rescind its prior authorization proposal for Medicare home health care services.
The deadline for signing the letter has been extended to Tuesday, May 24,so please act now using NAHC’s Legislative Action Center (available here) to contact your member of the U.S. House and request that they sign on to the letter today. By recruiting as many members of the U.S. House as possible to sign the Price-McGovern letter, NAHC members can help ensure CMS understands the concerns of the home health care community regarding this proposal.
In February, CMS issued a Paperwork Reduction Act Notice containing a proposal to institute a system of “prior authorization” on all home health services in five states. This proposal, which could easily expand to additional states, threatens Medicare beneficiaries and upstanding home health agencies because it would be costly, burdensome, and totally ineffective in preventing fraud and abuse.
In addition to Reps. Price and McGovern, at least 62 Representatives have signed the letter so far including: Reps. Ralph Lee Abraham (R-LA-5), Rick W. Allen (R-GA-12), Robert B. Aderholt (R-AL-4), Brian Babin (R-TX-36), Lou Barletta (R-PA-11), Diane Black (R-TN-6), Marsha Blackburn (R-TN-7), Robert Brady (D-PA-1), Mo Brooks (R-AL-5), Larry Bucshon (R-IN-8), Steve Chabot (R-OH-1), Katherine M. Clark (D-MA-5), Hansen Clarke (D-MI-13), K. Michael Conaway (R-TX-11), Kevin Cramer (R-ND), Eric A. Crawford (R-AR-1), Rodney Davis (R-IL-13), Jeff Duncan (R-SC-3), Sam Farr (D-CA-20), Louie Gohmert (R-TX-1), Tom Graves (R-GA-14), H. Morgan Griffith (R-VA-9), Glenn Grothman (R-WI-6), Andy Harris (R-MD-1), Vicky Hartzler (R-MO-4), Alcee L. Hastings (D-FL-20), Jeb Hensarling (R-TX-5), J. French Hill (R-AR-2), Richard Hudson (R-NC-8), David Jolly (R-FL-13), Walter B. Jones (R-NC-3), William R. Keating (D-MA-9), Joseph P. Kennedy III (D-MA-4), Ann Kirkpatrick (D-AZ-1), Doug Lamborn (R-CO-5), Michelle Lujan Grisham (D-NM-1), Stephen F. Lynch (D-MA-8), Kenny Marchant (R-TX-24), Tom Marino (R-PA-10), David B. McKinley (R-WV-1), Patrick Meehan (R-PA-7), Mick Mulvaney (R-SC-5), Richard E. Neal (D-MA-1), Randy Neugebauer (R-TX-19), Richard B. Nugent (R-FL-11), Pete Olson (R-TX-22), Gary J. Palmer (R-AL-6), Scott Perry (R-PA-4), Ted Poe (R-TX-2), Mike Pompeo (R-KS-4), David P. Roe (R-TN-1), Pete Sessions (R-TX-32), Teri A. Sewell (D-AL-7), Christopher H. Smith (R-NJ-4), Lamar Smith (R-TX-21), Jason Smith (R-MO-8), Glenn Thompson (R-PA-5), Mac Thornberry (R-TX-13), Scott Tipton (R-CO-3), Bruce Westerman (R-AR-4), Lynn A. Westmoreland (R-GA-3), Steve Womack (R-AR-3).
Prior authorization would result in delays in patient access to services and disruptions in the continuity of patient care, bringing increased risks for the patient during the transition from an inpatient setting in terms of infection, medication errors, and other factors. In addition, prior authorization would increase health care costs for providers and Medicare. For example, a one-day delay in discharging a patient from a hospital setting brings an average cost increase of $1,938 for Medicare. NAHC previously submitted comments on the proposal (see previous NAHC Report article here).
“We are deeply concerned that prior authorization would delay and impede access to services while potentially increasing costs to the Medicare program and taxpayers, by placing burdensome requirements on providers and jeopardizing patient safety and care continuity,” the Representatives said in a letter to their colleagues asking them to join in cosigning the letter to CMS. The letter additionally outlined the following concerns with the prior authorization proposal:
Negative Impact on Patient Care and Outcomes:
• Prior authorization will result in unnecessary disruptions in the continuity of patient care for especially vulnerable beneficiaries and may result in adverse events occurring during the transition from hospital to home, putting patients at risk for missing medications or exacerbating a chronic condition.
• Prior authorization will impede the timely delivery of care due to requiring physician-ordered services be reviewed and approved prior to care initiation. Adding extensive documentation to already highly regulated care is counterproductive.
Imposition of Costs to Medicare and Administrative Burden:
• Prior authorization could have the counterproductive effect of increasing costs to Medicare by delaying hospital discharges and burdening a system currently focused on transformative new care models, such as Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act (MACRA).
Again, the deadline for members of the U.S. House to sign the Price-McGovern letter is May 20 at noon. Please contact your Representative today to ask that they join Reps. Price and McGovern and cosign the letter to CMS. You can do so using NAHC’s Legislative Action Center (available here).