Illinois Congressional Delegation Asks CMS to Delay Pre-Claim Review

Earlier this month, CMS Administrator Andy Slavitt received a letter signed by every member of the Illinois Congressional delegation urging him to suspend the Pre-Claim Review Demonstration (PCRD) program in the state. Since the program began on August 3, providers have reported numerous improper care denials and technical issues with the state’s Medicare Administrative Contractor (MAC). Several of the program’s provisions, such as the requirement that physicians wishing to prescribe home-based treatment submit a detailed plan of care to the MAC before any care can be delivered, have been especially difficult to comply with.

“We urge CMS to immediately grant the state of Illinois the same PCRD delay that your agency has provided to Florida, Massachusetts, Michigan, and Texas, until education and guidance for home health providers, the state MAC, and patients are improved,” the letter reads. “If the lessons from Illinois prove that PCRD is not adequately developed for implementation in those states, then our constituents and provider organizations deserve the same consideration.”

Fortunately, CMS has already announced that it will suspend Pre-Claim Review in Florida and several other states after Illinois providers reported extreme difficulty complying with the new requirements. This comes as new reports show that between 60 and 80 percent of PCRD submissions have been rejected by the state’s MAC.

But there’s an even better fix. Recently, Representatives Tom Price (R-GA) and Jim McGovern (D-MA) introduced bipartisan legislation that would delay PCRD for at least a year.  The Pre-Claim Undermines Seniors’ Health (PUSH) Act (H.R. 6226) suspends PCRD’s implementation in all states where it was set to begin – including Illinois – and requires the Department of Health and Human Services to submit a detailed analysis of the program along with a list of alternative measures to identify improper Medicare payments. The Partnership supports this legislation and remain committed to working with patients, providers, and the federal government to find a more effective solution to fighting Medicare fraud without jeopardizing quality home healthcare.

Congress: Support the PUSH Act to Protect Seniors’ Home Health

Since the Centers for Medicare & Medicaid Services (CMS) rolled out pre-claim review for home healthcare in Illinois, providers across the state have encountered numerous delays and technical problems. Across the home health community, we’re already receiving reports of improper care denials from the Medicare Administrative Coordinators (MACs) that review Medicare home health claims. Several other providers have also reported issues using the MAC’s electronic submission system – resulting in long wait times and unnecessarily delaying patient services.

Fortunately, there is a fix. Last week, Representatives Tom Price (R-GA) and Jim McGovern (D-MA) introduced bipartisan legislation to suspend and delay further extension of pre-claim review to other states so CMS can make adjustments to the program. The Pre-Claim Undermines Senior’s Health (PUSH) Act would implement an immediate, one-year delay to pre-claim review and require the Department of Health and Human Services to produce a report detailing the program’s impact on patients, providers, and the Medicare system.

Specifically, the PUSH Act:

  • Delays the application of the demonstration in each State so it does not apply to episodes of care beginning earlier than one year after the earliest date that the demonstration was scheduled to begin in each State;
  • Calls on the Secretary to suspend the demonstration in a State for at least one year if the pre-claim review demonstration is underway at time of enactment. This would extend the program’s delay to Illinois, which is currently the only state in which this program was implemented.; and
  • Calls for a report to Congress no later than six months after the date of enactment to, among other things, analyze the impact of Medicare pre-claim review in any State in which it was implemented, describe the resources provided to physicians and home health agencies to conduct the demonstration, and outline alternative measures to identify improper payments with possible corrective actions

You can help protect vulnerable seniors who depend on home health seniors by emailing your Congressperson today and asking him or her to support this bill! Click below to get started:

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