Senators Ask for Halt to Pre-Claim Before Florida Start Date

Lawmakers in Florida have teamed up to ask Department of Health and Human Services (HHS) Secretary Tom Price to delay the implementation of the Pre-Claim Review Demonstration (PCRD) in the state.

PCRD is currently underway in Illinois and is set to go into effect in Florida beginning April 1, 2017. U.S. Senators Marco Rubio (R-FL) and Bill Nelson (D-FL) penned a letter to Price urging the agency to replace PCRD and delay the rollout of the current program. Of the 29 members of the Florida congressional delegation, 27 had signed on to the letter as of Friday, February 24, 2017.

PCRD, which requires home health care providers to submit claims documentation earlier on in the care process, is meant to target and combat fraud in the industry.

“We support efforts to combat Medicare fraud and protect taxpayer funds, but we are concerned that the PCRD’s current parameters are too broad to reduce fraud and improper payment rates,” the letter reads.

The program has been met with significant resistance from providers and association groups, which cited ongoing administrative burdens, compliance costs and high non-affirmation rates when the program first started in Illinois.

“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,” Kyle Simon, director of government affairs and communications at the Home Care Association of Florida (HCAF), tells Home Health Care News. “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.”

Illinois legislators attempted similar actions by writing a letter in October to Andy Slavitt, the former acting administrator at CMS. The letter came after PCRD was already in effect in Illinois and after CMS announced it would push back the implementation in Florida. PCRD was originally scheduled to begin in Florida by October 2016.

Lawmakers said the program’s challenges as seen in Illinois have raised concerns that the process jeopardizes seniors’ access to home health care. National associations, including the National Association for Home Care & Hospice (NAHC), and regional groups like the Home Care Association of Florida and LeadingAge Florida, have expressed that the program is not appropriate for combating fraud and adds regulatory burdens for agencies.

However, fraud in home health is a serious issue—the improper payment rate for home health reimbursements reached 59% in 2015. CMS has continued a moratorium on new home health agencies in certain fraud hotspots, including some of the same states where PCRD is expected to roll out.

The five states included in PCRD—Illinois, Florida, Michigan, Massachusetts, and Texas—have some of the highest fraud rates.

Home health associations are hedging their bets that putting pressure on HHS and Secretary Price could pay off—Secretary Price was the author of a bill last year to put a one-year moratorium on PCRD. He has also made comments indicating leniency with mandatory initiatives like bundled payments.

“In addition to meeting with lawmakers at town hall forums and in district offices across the state, provides will descend on Washington, D.C. next month to meet with every member of the delegation to encourage action to roll back PCRD,” Simon says.

Written by Amy Baxter