NAHC Official: Hope Dims for Pre-Claim Delay, CoP Relief More Likely

Home health agencies have cause to be optimistic about a delayed implementation of the new Medicare Conditions of Participation (CoP) rule, but with prospects appearing less bright for changes to the Pre-Claim Review Demonstration (PCRD), it’s imperative to continue beating the drum, according to one of the industry’s most prominent voices in Washington, D.C.

It’s impossible to say what the fate of proposed legislation and pending regulations will be, given that the current atmosphere in the nation’s capital is “chaotic,” William Dombi, vice president for law of the National Association for Home Care & Hospice (NAHC), said Wednesday at the Illinois Home Care & Hospice Council annual conference outside Chicago.

Still, even as Congressional lawmakers and the Trump administration try to push forward sweeping changes to the U.S. health care system writ-large, NAHC is pursuing home health objectives that it considers urgent.


One of these goals is a delay on the CoP rule, which was released in early January 2017; the massive rule updates the conditions that home health agencies must meet to participate in Medicare. Currently, the effective date for the rule is July 13, 2017. Another objective is to delay the start of the PCR demonstration in Florida—currently set for April 1, 2017—while also eliminating or reforming the program, which created massive upheaval when it was first implemented in Illinois last summer.

Hitting the Brakes on CoP

NAHC has requests in with the Centers for Medicare & Medicaid Services (CMS) and Sec. of Health and Human Services (HHS) Tom Price to push back the CoP effective date, Dombi said. He has a call scheduled with Patrick Conway, who has been serving as acting CMS administrator, for this Friday to continue the discussion.


“[Conway’s] most recent message was ‘We’re seriously considering a delay in the CoPs,” Dombi said.

While emphasizing that it is only his “impression” that CMS is amenable to a delay, Dombi outlined what he believes is a strong case for pushing back the effective date.

NAHC can make arguments for a delay under an executive order from the Trump White House on delaying the implementation of new regulations, he said. In addition, CMS has yet to issue any interpretive guidance to help agencies understand and adhere to the new rules, and surveyors have not been trained on how to judge compliance. Add to these arguments that the rule is costly—running to an estimated $293 million in the first year—and that there is no pressing reason to rush implementation.

“These CoPs are modernizing where we are with home health standards, not addressing a serious problem [with quality of care],” he said. “If it took 20 years to get to these rules, why are we rushing to an effective date?”

Specifically, NAHC is pushing for the effective date to be, at the earliest, six months after the interpretive guidance is issued and surveyor training is complete, Dombi said.

Diminishing Hope for Pre-Claim Pause

When President Trump named Tom Price as his pick to lead HHS, he stoked hope that the PCR demonstration might come to a swift end. That’s because as a U.S. Representative from Georgia, Price was a leading opponent of PCR, even introducing a bill to delay the program’s expansion to states beyond Illinois.

Now, though, it appears that PCR might go forward as scheduled in Florida next month—despite ongoing advocacy by home health providers and industry associations, which say that the demonstration does not root out fraud and abuse but does impose huge burdens on agencies. Under PCR, agencies must have documentation “affirmed” by Medicare auditors prior to submitting claims for payment, which has led to administrative bottlenecks, sharp cash flow concerns, increased staffing costs, and other challenges.

NAHC has been working with Price’s office, urging him to use his authority to stop PCR in Illinois and other states, but so far there has been no commitment to do so, Dombi said Wednesday.

“My concern is, day after day, hope of something for Florida diminishes because of time,” he said.

Part of the issue could be that Price is playing the lead role in the administration’s efforts to repeal and replace the Affordable Care Act, Dombi noted.

“In the scheme of his to-do list, what’s at the top, and where is PCR?” Dombi said.

Still, Price’s office says that they are sensitive to the PCR timeline, and NAHC believes they are “engaged” on the issue, according to Dombi.

The association also is in discussions with CMS to step back in Illinois and take a more targeted approach, to focus pre-claim review on agencies with lower affirmation rates rather than continuing to subject successful providers to the program’s requirements. CMS is “thinking about it, looking at the data,” Dombi said.

Written by Tim Mullaney

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