Five Reasons Prior Authorization Is Bad for Medicare Services

CMS is seeking comment on requiring prior authorization for Medicare home health, upon which approximately 3.5 million Medicare beneficiaries depend. Prior authorization means that a patient can’t receive the care her physician ordered unless and until a government official has reviewed that order (and a lot of other paperwork besides) and given it his blessing.

Learn why CMS should rescind this proposal:

  1. There is No Legal Authority for Prior Authorization for Medicare-Covered Services. CMS does not have authority to impose prior authorization for Medicare-covered services.
  2. It Will Have a Negative Impact on Patient Care and Outcomes. Prior authorization will impede the timely delivery of care because physician-ordered services will have to be reviewed and approved by a bureaucrat before care can be initiated. If delays were to occur in home health, medically frail seniors would face the risk of medical crises and higher readmission rates.
  3. It Will Impose Significant Financial and Administrative Burdens. Prior authorization will lead to higher costs, as patients that would otherwise be served in their home are instead referred to costlier settings, or return to hospitals.
  4. Prior Authorization Will Not Reduce Fraud and Abuse. Prior authorization will not stop those bad actors who are intent on defrauding the Medicare program. Instead, such criminals will submit false records to satisfy the prior authorization rules, just as they do for CMS’ other documentation requirements.
  5. Medical and Patient Advocates Want to be Part of the Solution! Home healthcare and other key stakeholders would welcome the opportunity to collaborate with CMS on the development and implementation of appropriate and targeted program integrity measures that fall within CMS’s authority and that would effectively identify and eradicate fraud and abuse without exposing patients to any risk or taxpayers to any increased cost.

You can urge CMS to set aside its prior authorization proposal by sharing this post on Twitter:

Click here to learn more about prior authorization. 

Congress: Harmful Medicare Home Health Cuts Still Need Repeal

by former Congressman Billy Tauzin

billy-tauzinWinter break has officially ended and Congress is back in session gearing up for a busy 2016. As we inch closer to the election, both parties are lining up their priorities for the coming months.

On the docket this week is a vote on a budget reconciliation bill to repeal major parts of Affordable Care Act (ACA) including individual and employer mandates, taxes on high-cost healthcare plans known as the “Cadillac tax,” and the further expansion of Medicaid.

These are big ticket items, but not the only ACA policies that deserve thorough review and repeal by lawmakers. When the ACA was signed into law five years ago, so were significant Medicare cuts that put American senior care at great risk.

One such policy is a cut to Medicare funding for home health beneficiaries – a patient group that is documented as Medicare’s most vulnerable population.

In January 2014, the Centers for Medicare & Medicaid Services (CMS) authorized a 3.5 percent annual cut spanning the years 2014-2017 as part of the ACA. When all is said and done, this will amount to an unprecedented 14 percent cut to the Medicare home health benefit, threating access to care for millions of seniors and the jobs of thousands of home health professionals nationwide.

Further exacerbating the effects of a crippling cut is the fact that Medicare’s 3.5 million home health beneficiaries are older, sicker, poorer and are more likely to be female, a minority, and disabled than all other beneficiaries in the Medicare program combined. For example, data compiled by Avalere health found that 24 percent of home health patients are older than 85, compared to just 12 percent of the general Medicare population and 51 percent of home health patients live with five or more chronic conditions compared to just 24 percent of non-home health Medicare beneficiaries.

The steep cuts to home healthcare are also a hard hit to our nation’s rural communities. For many seniors living in rural areas, home healthcare is a vital service as the nearest hospital or medical center may be miles away. Without access to home health, these seniors may be forced to seek care in a more expensive institutional setting or choose to forgo necessary medical care all together.

As federal lawmakers prepare to vote on repealing pieces of the ACA, I ask them to remember the 3.5 million vulnerable seniors who rely on clinically advanced, cost-effective and patient preferred skilled home healthcare services. As we enter the third year of the harmful ACA home health cuts, it becomes even clearer that repeated cuts are simply unsustainable.

As we enter this New Year, I urge Congress to not solely repeal the ACA provisions currently included in the Senate-passed budget reconciliation package, but also the deep Medicare funding cuts that were included in the ACA too.

Billy Tauzin is former Chairman of the U.S. House Energy and Commerce Committee and senior counsel to the Partnership.

Bring the Vote Home Releases New Polling Data & Launches a New Website

One year out from the 2016 general elections, Bring The Vote Home has released the results of new polling data, which surveyed more than 2,000 registered voters over age 65.

This polling data revealed that American seniors want a candidate who will be an advocate for them on issues specific to those over 65, including healthcare. The poll also concluded that individual states have room to improve helping seniors cast their vote, with only four in 10 seniors indicating their state does a good job educating homebound seniors on how to register or obtain an absentee ballot.

For this reason, Bring The Vote Home has also launch a brand new website to offer seniors, disabled Americans, and their healthcare clinicians the information they need to register to vote and receive an absentee ballot!

Bring The Vote Home was originally developed so that Medicare home health patients (who are homebound) could fully participate in the democratic process. BTVH has expanded to offer additional resources, including information about their lawmakers’ views on home health and senior polling data on the views and opinions of American seniors.

Learn more about Bring The Vote Home by visiting the new website and from the infographic below:

Remember to Honor our Veterans

Today is Veterans Day, an important time for Americans to pause and consider the sacrifices that have been made by our country’s servicemen and women. Even against great odds, they have defended our way of life with valor and steadfast devotion.

Our appreciation for those who have served our country should go beyond just a single day – especially as they grow older. As veterans age, it’s crucial that we ensure our nation’s heroes are able to access quality, cost-efficient, and dignified care.

In 1972, the U.S. Department of Veterans Affairs (VA) established the Home Based Primary Care (HBPC) program, which provides primary care services to veterans in their homes.

Since HBPC was created, the program as reduced preventable emergency room visits and inpatient hospital days for veterans, resulting in a 24 percent decrease in total healthcare costs.

In 2014, the VA expanded veterans’ access to home healthcare through the Caregiver Support Program, allowing Caregiver Support Coordinators to assist family caregivers of veterans and providing services to aid in caring for their loved ones.

There’s no way to fully repay the debt we owe to those who have served our country, but we can help show our gratitude and give back by providing necessary care in the best possible setting as our veterans grow older. Home healthcare has clearly become one of the single most important aspects of care for veterans.

The home healthcare community celebrates Veteran’s Day every day as we dedicate ourselves to improving the lives of those who defended ours.

Happy National Family Caregivers Month

November is National Family Caregivers Month, which is a time to recognize the valuable role family caregivers play in the lives of America’s home health patients.  Many of Medicare’s home health patients are able to remain at home – and out of institutional settings – while receiving essential care services because of the collective support of home health professionals and their family caregivers.


Nearly 89% of seniors say they want to age in place, or live independently and remain in their own homes while receiving care. However, home health patients are more likely to live and they are also some of the poorest, sickest, and most vulnerable beneficiaries in the Medicare program, underscoring the critical importance of family caregivers.

Without family caregivers, it would be much more difficult to coordinate and provide the care our seniors need and deserve – and we want to say thank you!

Our friends at the Caregiver Action Network have many tools to help family caregivers.  There are many ways you can learn more about the role family caregivers play for home healthcare patients and how you can say thanks, including:

  1. Hear stories from family caregivers or submit your own
  2. Read through the Caregiver Action Network family caregiver toolbox
  3. Visit a forum to discuss issues caregivers deal with frequently



133 Bipartisan Lawmakers Agree: We Must Save Home Health

133 Members of the U.S. House of Representatives recently expressed their deep concern with proposed Medicare home health funding cuts in a letter to the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt.


In June, CMS released the Home Health Prospective Payment System (HHPPS) proposed rule for 2016, in which the agency proposes to cut an additional $350 million from the Medicare program’s home healthcare benefit on top of the 14 percent rebasing cut imposed on the home health benefit in January 2014.

Cuts of this nature are troubling to lawmakers and the home health community alike.

If enacted, the cuts would put small and rural home health agencies – and their patients—at greatest risk. In areas where there is only one agency, data suggest closures will likely force patients to seek care in more expensive institutional settings or, far worse, avoid treatment all together. As data from Avalere shows, the Medicare beneficiaries served by home health are older, sicker, poorer and are more likely to be female, a minority, and disabled than all other beneficiaries in the Medicare program combined.

We applaud Representatives Greg Walden, Tom Price, Earl Blumenhauer and James McGovern for their leadership on this important senior care issue and thank their 129 House colleagues for taking action to protect seniors’ access to vital home health services. We look forward to our continued work with both Congress and CMS to ensure policies are put forth that protect cost-effective and clinically advanced healthcare services for seniors in the setting they prefer – their home.



Happy National Seniors Citizens Day!

Today is National Seniors Citizens Day! Across the country, home health professionals are celebrating our seniors by providing cost effective, clinically advanced care to more than 3.5 million Medicare patients in the setting they prefer.

As Ronald Reagan said when signing the National Seniors Day proclamation:

“We can best demonstrate our gratitude and esteem by making sure that our communities are good places in which to mature and grow older — places in which older people can participate to the fullest and can find the encouragement, acceptance, assistance, and services they need to continue to lead lives of independence and dignity.”

Many healthcare treatments that were only offered in a hospital or a physician’s office when President Reagan signed this proclamation can now be safely, effectively, and efficiently provided in patients’ homes by skilled clinicians.

The home health community is proud to be an active participant in providing the services our seniors need to age in place as so many prefer.

Home Health Care Services are at Risk for Rural America

Funding cuts made to Medicare home health in recent years are hurting home health providers and their patients across the country, particularly those operating in rural areas.

Powell Valley Home Care and Hospice (PVHC) has offered home health and hospice services in northwest Wyoming since 1989, but the company recently announced plans to permanently close its doors and say goodbye to their patients.

In recent years, Powell Valley Health Care’s home care and hospice services have operated at an annual loss of nearly $400,000 as a result of significant decreases in Medicare and Medicaid reimbursements.

PVHC is not alone in this financial struggle to provide care to Medicare’s most vulnerable seniors, especially those residing in rural communities. According to Avalere Health, 26 rural counties relied on a single home health agency in 2013, and an additional 27 counties were served by just two providers. All told, more than 631,000 Medicare beneficiaries in nearly 2,000 rural counties relied on home healthcare services in 2013.

The PVHC closure exemplifies the financial stress that rural home healthcare providers are experiencing as a result of recent Medicare cuts, which in turn threaten access for rural patients.

Despite the financial instability facing rural home health providers, the federal Medicare program is once again calling for deeper cuts.  Agencies could face another $350 million in cuts as part of the proposed Home Health Prospective Payment System (HHPPS) changes for 2016.

If more cuts are allowed to take place, further closures and patient dislocation will spread across the country, jeopardizing the health and well being of America’s most vulnerable elderly and disabled Medicare beneficiaries.

Home Health Programs Improve Care & Save Money

A recent report by the Center for Medicare & Medicaid Services (CMS) revealed what we’ve known for over 20 years – home-based care for the highest utilizers of Medicare services delivers quality care at a lower cost.

Yesterday CMS announced that a demonstration program to increase in-home primary care for patients with chronic conditions resulted in $25 million in savings for Medicare in its first year of a three-year study. The program seeks to determine the value of home-based primary care for frail seniors with multiple chronic illnesses by avoiding pricier hospital and emergency room care.

CMS found that the overall savings achieved averaged around $3,070 per beneficiary. Patients also experienced fewer hospital readmissions within 30 days and used hospital emergency departments less frequently for conditions such as diabetes, high blood pressure, and pneumonia.

This report is the latest of illustrate the clinical and fiscal value of home healthcare for Medicare’s sickest patients:

Programs such as Medicare’s Independence at Home demonstration project will continue to confirm what home health advocates, providers and their patients already know: home health provides cost effective, clinically advanced, and patient preferred care.

Celebrate Men’s Health Month

This month we join health care providers, public policy makers, the media, and others in celebrating Men’s Health Month. Anchored by a Congressional health education program, Men’s Health Month is celebrated throughout the country with screenings, health fairs, media appearances, and other health education activities.

The goal? To increase awareness of preventable health problems and encourage earlydetection and treatment of disease among men.

This year’s theme mirrors the last: Awareness. Prevention. Education. Family. 

Home healthcare helps provide quality care for over 1.4 million men in their own homes by skilled and highly trained clinicians. Awareness and prevention are key to keeping Medicare home health patients healthy and happy at home!

Be Aware: Not all Medicare beneficiaries know that home healthcare is available –an option that lets patients be treated where they’re most comfortable. Learn if you’re eligible for Medicare coverage of home healthcare and find out more about your options.

Get Treated: 86% of home health users have three or more chronic conditions.  Home healthcare helps patients avoid the risk of hospitalization including infection, delirium, depression, infection, and functional decline. Studies have shown that the frail and elderly have a 23.3% risk of being unable to return home after even a very short hospitalization.

Get the Facts: Approximately 59.2% of Medicare beneficiaries receiving home healthcare have an annual income under $25,000. This skyrockets to 81% for minority populations. Partnership for Quality Home Healthcare is helping to ensure that skilled home health services remain an option for those who need them most. Check out the issues we’re working on with Congress to make sure that home healthcare remains a priority.

For many men, home healthcare plays an important part in ensuring quality, preventative care in the most comfortable space: Home. Together, we can continue advocating for Congress to meet seniors’ needs and reducing American healthcare costs through home healthcare.