This week, TAHC&H president elect, Jennifer Lopez and Executive Director, Rachel Hammon, traveled to Washington DC for a well-attended public policy summit and to visit with legislator’s on the hill before their August recess. Two topics were at the top of the agenda, F2F (along with all the related consequences agencies have suffered) and the CMS pre-claim review demonstration.
As F2F is at the root cause of the majority of the denials with both routine ADRs and the most recent probe and educate initiative, it is no surprise that F2F makes pre-claim absolutely undoable. That said, TAHC&H has made fixing F2F a huge priority and since pre-claim review was announced, taken that up with the same vigor.
We are pleased to announce a huge success in moving the ball forward on F2F that happened this week while we were in DC. TAHC&H worked with Oklahoma to gain F2F relief report language in the House Appropriations Labor HHS Bill that was just approved by the full House Appropriations Committee on Thursday. This language was championed by Rep. Henry Cuellar (D)-TX. TAHC&H members and staff worked closely with Rep. Cuellar to develop the language and then work in a bi-partisan way with Rep. Tom Cole (R) - OK, to get the language included on the bill. This was truly a bi-partisan, multi-state effort. This same thing was attempted last year by the national associations and other state associations without success.
The following language was included on the bill:
Access to Home Health Care.—The Committee is aware that the current requirement that home health plans be solely certified by a physician has resulted in problems with access to home health care. The Committee urges CMS to ensure access to home health care by considering methods to waive the requirement that home health plans be solely certified by a physician. The Committee also requests CMS consider the entire record of documentation and not require a subjective component regarding an individual in determining whether home health services meet the requirements for coverage. The Committee requests CMS take authorized steps to address the backlog of face-to-face appeals like allowing comparable documentation to satisfy the face-to-face requirements, such as those recently referred from the hospital setting, to be exempt from the face-to-face requirement. The Committee requests an update in the fiscal year 2018 budget request on these efforts.
So what does this mean? Although this is not as strong a “bill” language, it does require CMS to report back to congress what they are doing to comply with the language above. According to this language, CMS would have to tell congress how they are waiving the requirements for F2F after a hospitalization, how they are waiving the requirements for POCs to be certified solely by a physician, how they are not requiring a subjective component of documentation to determine eligibility, and how they are addressing the backlog of appeals. In order to give a positive report to congress, CMS will have to address these issues.
This is a great step forward and the first time that any F2F relief language has been included on a bill that is actually moving in congress and has to pass. But we are not done and TAHC&H has no plans to stop here. We are also working on an actual stand-alone bill that is currently in draft with the House Energy and Commerce Committee. This is actual bill language that includes the components listed in the report language above in greater detail. We have also received positive feedback from the House Ways and Means Committee that once the bill is filed they will also take up the language to include it in any legislation that they may file.
The key here is to 1) get the legislation filed and 2) find a bill that will move and be voted on before the end of the year. That process will start up again in September after the August recess.
We also met with several key legislators on the pre-claim review demonstration and shared the State collaboration letter TAHC&H spearheaded and sent directly to CMS. In addition to our own Texas delegation, we were able to meet with Dr. Price’s (R) - GA, office who has championed letters to CMS, such as the sign on letter about prior authorization and is currently heading up a new letter regarding the pre-claim review.
Fortunately for Texas we are the third roll-out of pre-claim review to start no earlier than December 1, 2016. This will give us the time we need to work hard to mitigate this issue. We are currently planning three workshops with Palmetto GBA on the subject, so keep an eye open for registration as spots will fill up fast. Additionally, stay tuned for a TAHC&H alert as to how you can continue to be involved expressing your concerns about F2F and the upcoming pre-claim demonstration.