Congress Weighs in on Home Health Prior Authorization Proposal, Impact on Patients
June 01, 2016
demonstration that would require prior authorization for all home health
services could put the oldest and frailest Medicare beneficiaries at risk. Ten
members of the Pennsylvania delegation joined more than 100 U.S. House
colleagues in urging the Centers for Medicare & Medicaid Services (CMS) to
withdraw the proposed demonstration.
year, CMS announced a Medicare prior authorization of homehealth services demonstration
proposing that all home health services in Florida,
Illinois, Massachusetts, Michigan, and Texas receive prior authorization.
this policy, a patient would not be able to receive home health services ordered
by a physician until an intermediary reviewed and approved the order.
health care follows an inpatient hospital stay, services often begin
immediately. Patients leaving the hospital typically are not able to wait
multiple days for home care, while a prior authorization is reviewed and
Any delay in starting
home health care services that result from a prior authorization process may
lead to an increase in the number of avoidable, clinically risky, and costly
outcomes, including longer lengths of stay in hospitals and higher readmission
The U.S. House letter to CMS stated concerns that the prior
authorization requirement would cause:
- Disruption and delay in patient care, which will
put the oldest and frailest Medicare beneficiaries at greatest risk
- Limitations in access to home health services,
generating longer and costlier hospital stays
- Increased costs to taxpayers and administrative
lawmakers who signed the letter to CMS included: Lou Barletta (R, PA-11), Bob
Brady (D, PA-01), Ryan Costello (R, PA-06), Charlie Dent (R, PA-15), Mike Kelly
(R, PA-03), Tom Marino (R, PA-10), Pat Meehan (R, PA-07), Scott Perry (R,
PA-04), Bill Shuster (R, PA-09) and GT Thompson (R, PA-05)
submitted a letter to CMS arguing the proposal could have negative
ramifications for patients by:
a barrier to time-sensitive delivery of care
counter to the goals of delivery and payment reforms intended to improve
transitions of care
expressed opposition to subjecting home health services to prior authorization.
If CMS moves forward with the policy, HAP stated that home health services
directly following an inpatient stay—whether from an acute care or post-acute
care hospital, nursing home, or long-term care facility—should be exempt from
any prior authorization policy or process that CMS may ultimately implement.
Contact Jennifer Jordan, HAP’s vice
president, regulatory advocacy, with questions regarding the policy or Laura Stevens Kent, HAP’s vice
president, federal advocacy, regarding Congressional activity.