As we move into 2017 and welcome a new Administration and Congress, the Partnership has outlined policy priorities for 2017. While it is hopeful that the new Administration will provide regulatory relief from multiple, duplicative programs detailed below, the Partnership will continue to press on with Congress to make critical changes.
Last year, the Centers for Medicare & Medicaid Services (CMS) introduced the Pre-Claim Review for home health demonstration project. Under the demonstration, home health agencies would need to receive approval from a CMS contractor before being reimbursed for providing home health services – even if those services were prescribed by a patient’s physician. While the original purpose of this demonstration was to address fraud, a combination of technical failures and contractor mismanagement has led to significant and unnecessary delays in home care delivery while doing little to tackle fraudulent claims.
Thankfully, CMS suspended pre-claim review in several states where it was slated to begin this year. However, the demonstration remains active in Illinois, the first state in which the program was implemented, and is scheduled to take effect in Florida early this year. In 2017, the Partnership will be renewing its efforts to pass the Pre-Claim Undermines Seniors’ Health (PUSH) Act, bipartisan legislation to delay pre-claim review for one year so CMS can determine how to strengthen the program and prevent care disruptions.
The Partnership also welcomes the opportunity to work with CMS simultaneously to address our concerns with pre-claim review and delay implementation of the program in other states.
Face to Face Requirement
Under current Medicare rules, patients who need home healthcare must have a documented face-to-face encounter with a physician to certify their eligibility for services. This is to ensure that patients are receiving care in the appropriate setting and providers are not billing Medicare for unnecessary services. However, overly complicated and burdensome requirements have resulted in unintended consequences like care delays and improper denials of services.
Data show tens of thousands of claims have been denied for care that is medically necessary and appropriate. While many of these claims are overturned on appeal, the initial denials make it difficult for home healthcare agencies to provide continued, uninterrupted care.
This year, we will work with our partners in Congress to develop legislation to streamline the existing face-to-face documentation rules to reduce the paperwork burden on physicians and home health agencies so that there are fewer improper care denials.
According to recent data, the cost of providing Medicare home health services is 36% higher per parent episode in rural areas than it is elsewhere. This is primarily due to increased transportation and staffing costs, which make it difficult for home health agencies to balance their operating costs with reduced Medicare reimbursement rates. Medicare home health patients in rural areas are also older, on average, than the general Medicare population and are more likely to be dually eligible for Medicare. Therefore, ensuring continued access to home health services is critically important for rural beneficiaries.
Since the year 2000, Medicare had recognized this disparity and has provided a rural safeguard to ensure older Americans living in rural areas have access to home healthcare. Currently, the safeguard is set at a 3% add-on to the baseline reimbursement rate. However, this provision is set to expire at the end of 2017 if Congress doesn’t act to extend the safeguard.
We will make extending this valuable rural safeguard a top priority in 2017 so that America’s rural communities can rest assured that they will always have access to skilled care at home.