Bipartisan Group of House Members Ask Medicare to Rescind Its Prior Authorization Proposal
May 26, 2016 09:07 AM
A bipartisan group of House members led by Congressman Tom Price (R-GA) and James F. McGovern (D-MA) sent a letter to Department of Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare & Medicaid Services Administrator Andrew M. Slavitt calling for the withdrawal of the recently proposed use of prior authorization for all home health claims in five targeted states. The letter’s sponsors were joined by a diverse group of House members totaling 116 signers of the letter.
The House letter strongly states, “[w]e encourage you to refrain from moving forward with the proposed demonstration project in order to avoid delays or disruption in patient care and prevent restrictions on patient access to home health services.” Stating that prior authorization will interfere with the patient-physician relationship, the House members raise concerns that it “will effectively delay and deny home health care coverage for countless Medicare beneficiaries” and create an “unwarranted disruption and delay in patient care [that] will put the oldest and frailest Medicare beneficiaries at greatest risk.”
The House letter adds that there are concerns regarding “costlier hospital stays” and increased hospital readmissions along with “increased administrative burdens on both physicians and home health agencies, while likely adding little value for identifying and preventing fraud.” The 116 members of Congress also are critical that “[r]ather than a more focused approach targeting bad actors, this proposal will put a tremendous administrative burden on agencies with absolutely no track record of fraud.”
Getting 116 bipartisan members of Congress to send such a forceful letter to Medicare is no easy task. It happened because of the great efforts of the NAHC membership nationwide working in partnership with the Forum of State Associations to push for 10 consecutive days to convince members of Congress to sign on. With the leadership of Congressmen Price and McGovern, members of Congress from nearly every state joined together to get there strong message to Medicare to “withdraw the proposed demonstration for prior authorization of home health services in order to avoid health risks to patients, delays or disruptions in patient care and unnecessary restrictions on patient access to home health services.”
What happens next? For starters, Medicare has a lot to think about regarding the future of home health prior authorization. Along with the assertive House letter, Senators from the directly affected states have also weighed in with their concerns with the proposal. In addition, NAHC and 35 others, including patient advocacy groups, have submitted detailed comments to CMS expressing all the same concerns raised by members of Congress and more. Among those concerns is the legal validity of the proposal in terms of the authority to implement prior authorization and the process by which CMS initiated its proposed action.
NAHC intends to keep this issue on the “front burner” and utilize all available avenues to derail the prior authorization proposal as it is now structured. We intend to continue to work with all of our congressional allies in the House and Senate. If needed, we will seek the introduction of legislation to block the proposal. Finally, a lawsuit remains an option down the line if CMS advances its proposal to implementation.
The letter sent by Congressmen Price and McGovern and the others is available here. In addition, we have included a list of the signers by state available here.