HCA this week submitted a strongly worded comment letter opposing a prior authorization demo for Medicare home health services being floated by the U.S. Centers for Medicare and Medicaid Services (CMS).
We are also part of a nationwide effort, in collaboration with partner state associations throughout the country, weighing in jointly on the rule, all calling for the rule to be rescinded.
As part of the proposed demonstration, CMS would perform prior authorization before processing claims for home health services in five identified demo states: Florida, Texas, Illinois, Michigan and Massachusetts, though it is possible that this pilot could be extended to New York and other states as well.
More information on the proposed demo is at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10599.html?DLPage=4&DLEntries=10&DLSort=1&DLSortDir=descending.
As HCA explains in our comment letter, “this proposal would create altogether unnecessary obstacles in access to care, increase system-wide costs, and jeopardize the quality of care that patients receive.”
We also take aim at the justifications and inherent contradictions of this proposed rule compared to other federal regulations and initiatives.
HCA’s letter can be read at https://hca-nys.org/wp-content/uploads/2016/04/Medicare-Home-Health-Prior-Authorization-Comments-Final.pdf.