Action Alert: Tell Your Elected Representatives to End Pre-Claim Chaos!
September 19, 2016 03:44 PM
The National Association for Home Care & Hospice (NAHC) is asking everyone to contact their members of their members of Congress and ask them to urge the Centers for Medicare & Medicaid Services (CMS) to rescind its prior authorization proposal for Medicare home health care services.
The Pre-Claim Review (PCR) Demonstration in Illinois, which began on August 3, 2016, has created a chaotic and expensive mess. Home health agencies (HHA) are encountering a 60-80 percent non-affirmed rate, with reasons for denials often contradictory, nonsensical or non-existent. PCR features a time-consuming new paperwork burden, an inefficient electronic system that cannot process the documentation, physician unfamiliarity with what is needed for PCR due to poor education from the Center for Medicare and Medicaid Services (CMS), all leading to considerable cash flow problems at agencies. At least one Illinois HHA has closed due to PCR and others may soon follow. This is forcing HHAs to withhold the start of patient care until a favorable decision is received, resulting in longer hospital stays, which waste money. This, of course, defeats the purpose of PCR, which is to eliminate unnecessary cost. An average day in an Illinois hospital costs $2025, but a home health visit costs a mere $168, so every single day a patient spends in a hospital when he or she should and could be receiving treatment at home, is a significant unnecessary cost. The Pre-Claim Review Demonstration is defeating its own purpose!
In the coming weeks and months, PCR is scheduled to spread to Texas, Florida, Michigan and Massachusetts. After that, pre-claim review could spread to the entire country. There are 3.5 million homebound Medicare beneficiaries who depend on the Medicare home health benefit and they – and their providers – all stand to be negatively affected if PCR is allowed to stand.
Due in part to NAHC’s efforts, 116 bipartisan members of Congress signed a May 25, 2016 letterto CMS calling for the withdrawal of the original prior-authorization proposal. In addition, Rep. Tom Price (R-GA), whom NAHC has worked closely with on this issue, asked at a September 7 House Ways and Means subcommittee hearing on Medicare if the country would be “aided by a delay in this demonstration so CMS can get their act together?” NAHC also worked with Senators Bill Nelson (D-FL) and Marco Rubio (R-FL) to send a letter to CMS requesting the PCR demonstration not expand beyond Illinois.
As we detailed here at NAHC Report last Friday, our staffers have been storming Capitol Hill, meeting with members of Congress and their offices to stop pre-claim review. However, lending your voices to the cause would make our appeals to lawmakers more powerful.
Please head over to NAHC’s Legislative Action Center and join the well over 100 members of Congress who have urged CMS to end the failed Illinois pre-claim review experiment and not let it spread to other states.