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CMS Announces Plans for Home Health Prior Authorization Requirement

Posted on Thursday, June 9, 2016 1:11 PM

Although the home health industry and lawmakers were trying to avoid a preauthorization requirement, CMS announced Wednesday the intentions to continue with the plans.

Prior authorization, now called the Pre-Claim Review Demonstration for Home Health Services, will be introduced in five states as announced in February. The goals are to tighten up on Medicare Fraud and abuse.

The demonstration will roll out to the following states in this order:
• Illinois after August 1
• Florida after October 1
• Texas after December 1
• Michigan after January 1
• Massachusetts after January 1

The program will require home health agencies in select states to perform prior authorization before processing claims for services.

“The main change under this demonstration is that HHAs will submit the supporting documentation while beneficiaries are receiving care,” according to a news release from CMS. “This earlier submission of documentation will undergo the new ‘pre-claim review.’”

The demonstration was introduced due to a 59% improper payment rate among home health claims in 2015, CMS stated.

CMS’ proposal has received disapproval from the industry, and even those receiving home health services.

“When provided information on prior authorization for home healthcare services, senior voters have warranted concerns about how a demonstration might affect their access to needed skilled care in the home following an inpatient stay,” Keith Myers, Chairman of the Partnership for Quality Home Healthcare, said in a statement.

View a copy of the rule here.

For the full article, click here.

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