Take action today to protect home health from pre-claim review!
TAHC&H urges
all members to contact their Members of Congress to halt the Centers for
Medicare and Medicaid Services (CMS) "pre-claim review (PCR)"
demonstration in Illinois and delay it in Florida, Texas, Michigan, and
Massachusetts in order to avoid any disruptions to patients attempting
to access home health services.
Unfortunately, CMS will begin the demonstration in Illinois on August 1st and in Texas as soon as December 1st despite receiving a Congressional letter supported by over 110 Members of Congress (here), numerous stakeholder comment letters (here) and a state delegation letter led by TAHC&H (here).
TAHC&H
has participated in all the Open Door Forums as well as communicated
directly with CMS and its contractor on all the serious problems related
to the continually changing regulatory requirements for providers.
There are no clear assurances that CMS contractors have the capacity or
the ability to administer such a complex and large change to how patient
care and access is currently provided. For these reasons and those provided in our stakeholder comments, TAHC&H remains firmly opposed to the home health pre-claim review demonstration.
As
further background, in February, CMS proposed a demonstration program
for Medicare home health prior authorization in 5 designated states
including Texas. The demonstration program, which was announced in a
Paperwork Reduction Act notice in the Federal Register (here), means
CMS would have to review and approve home health services before any
Medicare beneficiary could begin receiving services. CMS then changed
the demonstration to a pre-claim review program, another name for prior
authorization, that will cause confusion amongst vulnerable patients and
delays or interruptions in critical medical services.
Please call and email your federal Representative to ask them to contact CMS to stop the pre-claim review demonstration that targets Texas.