Advocates ‘Turn Up the Volume’ on Effort to Delay Pre-Claim

Much attention has been focused on what will happen in the nation’s capital after Donald Trump is sworn in as President in January, but Congress currently is in session and still could act on an important piece of home health legislation. With this in mind, a coalition of home health providers is ratcheting up its efforts with legislators in Washington, D.C.

Specifically, the Partnership for Quality Home Healthcare—a group representing community- and hospital-based home health agencies nationwide—is urging Congress to pass the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016. This bill would delay by one year the Pre-Claim Review (PCR) demonstration, which was implemented by the Centers for Medicare & Medicaid Services (CMS) in August.

PCR currently is underway in Illinois. Originally, the program was to roll out to four additional states, but CMS hit the pause button on the demonstration following a huge outcry after a rocky rollout in the Land of Lincoln.


Under PCR, agencies must submit documentation to an auditor for pre-authorization before filing for Medicare payments. This imposes tremendous administrative burdens, and high rates of “non-affirmed” pre-claim submissions could result in cash flow being constricted to such an extent that providers might be driven out of business, agencies have said. The home health industry has embarked on a multi-faceted campaign to have PCR delayed and/or significantly revamped or ended entirely.

The introduction of the PUSH Act in late September was one important milestone in that effort. It currently has 15 co-sponsors, and part of the Partnership’s current effort is to drum up more support.

“We’re doing a co-sponsorship drive,” Colin Roskey, executive vice president of the Partnership, told Home Health Care News. “It will probably include elements of grassroots support from members of the home health community, especially in Illinois, to express themselves both in written letters and social media. And that is accompanied by traditional lobbying efforts that the Partnership is undertaking through itself and member companies to turn up the volume and attempt to get more co-sponsors on the bill in the next week or so, before Congress adjourns.”


There now are 13 Republicans and two Democrats co-sponsoring the bill.

As for whether the bill has a realistic shot at getting passed, Roskey acknowledges that one potential route—being attached to the 21st Century Cures bill—did not come to pass. However, this is not a reason for pessimism, he said. There will be additional pieces of legislation that it could be attached to, or it could be brought up as a standalone policy.

“[The bill] still has opportunities to move this year,” he said. “We’re confident it has good support from bipartisan members.”

Adding another wrinkle, the bill’s original sponsor was Rep. Tom Price, M.D. (R-GA). This week, President-elect Trump named Price as the nominee to be Secretary of Health and Human Services (HHS).

It’s too early to tell whether Price’s nomination has changed the prospects for the PUSH Act on the Hill, Roskey said.

If Price is confirmed to lead HHS, he would have the authority to end the demonstration even without Congressional action.

Still, the Partnership is planning to keep the legislative wheels turning on this issue, Roskey said.

“Congress can act on it any time until they adjourn, and if they don’t get to it, we intend to look for a way to reintroduce the bill early in the next session,” he said. “[Pre-claim] has been held in abeyance by CMS, but we don’t expect that that continuance will [last] forever, so I would really look for the Partnership and other aligned organizations like NAHC and VNAA to be pushing very hard in the early days of December to put it in the best possible position.”

Written by Tim Mullaney

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