House members urge HHS to withdraw home health prior authorization proposal

Up to 116 members of the U.S. House of Representatives this week urged the Department of Health and Human Services to withdraw its proposed demonstration for prior authorization of home health services “to avoid health risks to patients, delays or disruptions in patient care and unnecessary restrictions on patient access to home health services.” The Centers for Medicare & Medicaid Services’ proposal would subject all home health services in Florida, Illinois, Massachusetts, Michigan and Texas to prior authorization or a 25% payment reduction in an effort to reduce fraud and abuse. “This demonstration project could limit access to home health services, while generating longer and costlier hospital stays and potentially increasing readmission rates,” the House members wrote. The letter was sponsored by Reps. Tom Price (R-GA) and James McGovern (D-MA). Commenting on the proposed demonstration last month, AHA urged CMS to replace its prior authorization proposal with interventions that target those HH agencies with likely fraudulent practices.