PUSH Act Introduced to House to Delay Pre-Claim Review

WASHINGTON, D.C. (September 29, 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—commended Congressmen Tom Price, MD (R-GA) and Jim McGovern (D-MA), as well as original cosponsors Reps. Kenny Marchant (R-TX), Mac Thornberry (R-TX), Louie Gohmert (R-TX) and Buddy Carter (R-GA), for introducing the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016. The legislation delays the Medicare demonstration for pre-claim review of home health services for one year to allow Congress, the Centers for Medicare & Medicaid Services (CMS) and home health stakeholders to work together to strengthen the program and improve education and training to ensure patient care is not delayed or that individual beneficiaries are not unjustly denied coverage.

As currently imposed, CMS’s pre-claim review demonstration increases documentation requirements on already burdened high quality home health agencies that could result in poor care transitions and confusion among physicians and their senior patients 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.

The Pre-Claim Undermines Seniors’ Health (PUSH) Act (H.R. 6226) would delay the demonstration by one year to ensure that its application would not negatively impact patient care. Specifically, the legislation:

• Delays the application of the demonstration in each state so it does not apply to episodes of care beginning earlier than one year after the earliest date that the demonstration was scheduled to begin in each state;
• Calls on the Secretary to suspend the demonstration in a state for at least one year if the pre-claim review demonstration is underway at time of enactment; and
• Calls for a report to Congress no later than six months after the date of enactment to, among other things, analyze the impact of Medicare pre-claim review in any state in which it was implemented, describe the resources provided to physicians and home health agencies to conduct the demonstration and outline alternative measures to identify improper payments with possible corrective actions.

“We applaud Congressmen Price and McGovern for listening to the concerns of the Medicare home health community and leading efforts in Congress to delay the pre-claim review demonstration,” said Colin Roskey, executive vice president of the Partnership. “We urge lawmakers to pass this bill to allow time for CMS and home health leaders to come together to study the consequences of this program and make necessary changes to ensure all stakeholders are prepared for its implementation so that patient care is not compromised.”

On August 3, the pre-claim review took effect in Illinois, the first state selected to take part in the demonstration. Since that time, providers have reported challenges navigating the program’s requirements, underscoring the need for legislation to delay pre-claim review to ensure the demonstration does not disrupt continuity of care for patients requiring home health.

“This legislation offers the relief the Medicare home health community has been seeking. We look forward to working with lawmakers in Congress to see that this bill is enacted and with CMS to improve the pre-claim review processes for the benefit of Medicare contractors, physicians, home health agencies, and most importantly, patients,” added Roskey.

Visit homehealth4america.org for more information.