CMS Challenged to Revise Pre-Claim Review Demonstration

WASHINGTON, D.C. (August 2, 2016)—The Partnership for Quality Home Healthcare—a coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home health care for our nation’s seniors—has expressed disappointment that the Centers for Medicare & Medicaid Services (CMS) is proceeding with the implementation of the pre-claim review demonstration applicable to all home health agencies in the state of Illinois on August 1.

“The Partnership and the broader Medicare home health community are concerned about this program. There are almost 200,000 Medicare patients in Illinois who may be affected. There are many home health care workers who are important in delivering health care services in the home on a daily basis,” said Colin Roskey, executive vice president of the Partnership. “We want to work with CMS to find ways to reduce errors in filing claims. Physicians and other practitioners who order home health care want to do it correctly. We urge CMS to press the “pause” button and find a better solution.”

CMS’s pre-claim review demonstration is scheduled to affect seniors in five states during the next three years—with the potential for national application—by imposing further documentation requirements on already burdened high quality home health agencies that could result in poor care transitions and still further confusion for seniors and their physicians seeking care at home. Home health leaders have warned that that pre-claim review policies will lead to higher Medicare and patient costs, as patients who would otherwise be served in their home may be referred to higher cost settings.

Lawmakers on both sides of the aisle have echoed the Partnership’s concerns, warning such policies could cause complications in the timely and seamless delivery of home health services. Data compiled by Avalere Health reveal that Medicare home health beneficiaries are older, sicker, poorer and are more likely to be female, a minority and disabled than all other beneficiaries in the Medicare program combined. Nationwide, 3.5 million homebound Medicare beneficiaries depend on the Medicare home health benefit.

“The Partnership supports the delivery of the most clinically appropriate and cost-effective care for older Americans, which is often made available through Medicare home health care. Burdensome new policies that complicate and constrain access to home health could unnecessarily drive patients into higher cost settings as ordering physicians struggle to meet the demonstration’s new requirements,” added Roskey. “We will continue to work with lawmakers and CMS as we track, research and evaluate the impacts of the pre-claim review demonstration in Illinois so that we understand the consequences of the demonstration before it is advanced in other states.”

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