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Congress Weighs in on Home Health Prior Authorization Proposal, Impact on Patients

June 01, 2016

A proposed 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.

Earlier this 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.

Under 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.

When home 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 approved.

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 rates.

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 burdens

Pennsylvania 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)

HAP also submitted a letter to CMS arguing the proposal could have negative ramifications for patients by:

  • Creating a barrier to time-sensitive delivery of care
  • Running counter to the goals of delivery and payment reforms intended to improve transitions of care

HAP’s letter 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.

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