Editor’s Picks: Prior Authorization Is Here

This week, Home Health Care News readers were among the first to know that the Centers for Medicare & Medicaid Services (CMS) officially plans to launch the home health prior authorization requirement in five U.S. states. Readers also learned why some experts believe an overtime wage rule will not impact the home care industry too much, how long a couple in our nation’s capital will spend in jail for Medicaid fraud, and how “CCRCs without walls” are breaking the mold.

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CMS Launches Home Health Prior Authorization Requirement—Despite pushback from the home health industry and lawmakers, CMS announced this week it plans to move forward with a preauthorization requirement. CMS’ plans for prior authorization, now called the Pre-Claim Review Demonstration for Home Health Services, will roll out in five states as announced in February.


New Overtime Rule May Pose Little Threat to Home Care—A new wage rule that increases overtime benefits for millions of American workers is expected to put some wage pressures on employers across many industries, but how much it will impact home health care is still up for debate. “We really don’t think this is going to impact home care at all,” said Caitlin Connolly, home care fair pay campaign coordinator with the National Employment Law Project (NELP). “There are very few home care workers who are salaried workers.”

Husband, Wife Get Prison Time in $80 Million Medicaid Fraud Scheme—The husband-and-wife owners of a Global Healthcare, Inc., a Washington, D.C.-area home care agency, have been sentenced to 17 years combined in prison for participating in an $80 million Medicaid fraud scheme.

More CCRCs Extend Services into Seniors’ Homes—Home care providers across the country may be seeing new opportunities for business due to the growth of a particular type of program: the continuing care retirement community (CCRC) “without walls.” There currently are 29 of these types of programs nationwide, with more under development, according to the latest figures from Ziegler and CliftonLarsonAllen LLP.


Weekend Reads

Tiny Trailer Homes for Families in Need—In a twist on the “tiny home” trend, New Brighton, Minnesota-based NextDoor Housing sells and rents out handicapped-accessible, 240-square-foot trailers designed to sit temporarily in homeowners’ backyards when a family member can’t quite live on their own.

Finding Ways to Keep Patients at Home—”When we talk about advance directives and reducing costly and unnecessary treatment at the end of life, we should also be talking about ways we can provide more support,” David Casarett is a professor at the University of Pennsylvania Perelman School of Medicine, writes in The New York Times. “We need to make sure that people like my patient have access to the kinds of care that can help them remain safely and comfortably at home.”

Written by Mary Kate Nelson

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