Led by U.S. Senator Bill Nelson (D), Florida’s congressional delegation this week called on federal regulators to delay a Medicare demonstration that could jeopardize access to Medicare-funded home health care services for Florida seniors.
In a letter to the U.S. Department of Health and Human Services Secretary Tom Price, 27 members of the congressional delegation called for replacement of the Centers for Medicare and Medicaid Services’ (CMS) Pre-Claim Review Demonstration (PCRD) with a “more effective program integrity initiative that better targets fraud.”
PCRD was announced by CMS in June 2016 and requires an intermediary to pre-approve payment for Medicare home health services. Florida is one of five states selected by regulators to participate in the mandatory program. Following implementation in Illinois in August 2016, Medicare home health agencies have widely reported challenges navigating the program’s requirements, including:
- Physical therapy denied
- Nursing care for knee replacement patients denied
- Medicare Administrative Contractors questioning “medical necessity”
- Technology flaws delaying affirmations
- Lack of clarity on requirements and processes
- Significant administrative burden
Senators Nelson and Marco Rubio previously sent a letter to federal regulators last fall, which successfully resulted in the delay of PCRD from going into effect on October 1, 2016.
“Lawmakers from both parties representing urban, suburban and rural districts spanning from the Panhandle to Key West signed on to the letter, demonstrating a united front before federal regulators that Pre-Claim Review is a costly, burdensome and ineffective demonstration,” said Kyle Simon, director of government affairs and communications for the Home Care Association of Florida (HCAF). “HCAF and its members are encouraged by the show of support by our federal representatives, and cautiously optimistic that a delay will be granted by HHS Secretary Price.”
“The home care community in our great state has been saddled with just about every initiative that policy makers in D.C. have dreamed up,” said Anthony Clarizio, president of HCAF. “From aggressive audits to reimbursement-related programs Value-Based Purchasing, and now with the Pre-Claim Review Demonstration looming large on the horizon, the level of scrutiny on home care is unparalleled, and no other state has had to contend with it as much as Florida.”
Nearly 350,000 Medicare beneficiaries across Florida depend on home health services provided by 1,124 Medicare agencies every year.
Founded in 1989, the Home Care Association of Florida is a 501(c)(6), not-for-profit, statewide trade association representing Florida’s home care industry. For more information, visit HomeCareFLA.org.