Home health providers push back against preauthorization proposal

A recently proposed federal rule that requires preauthorization for home health services would delay care and drive up costs as patients are forced into more expensive inpatient treatment, according to a coalition of home health providers.

In February, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that included a preauthorization pilot project in Florida, Texas, Illinois, Michigan and Massachusetts. Federal authorities have been targeting home health fraud, with clinicians and executives facing as much as 80 months in prison.

However, according to a letter submitted by Partnership for Quality Home Healthcare (PQHH), the new rule will delay necessary services for home health beneficiaries, forcing them to seek care at hospitals. The provider organization argued that CMS could better address the industry's improper payment rate by refining regulations and enforcement of face-to-face encounters. PQHH added that pre-authorization is "ill-suited to targeting fraud and abuse" since bad actors will not be deterred by the new requirements.

The letter echoed concerns from other home health providers that submitted comments about the proposed regulation, arguing that the sweeping changes would be a substantial burden for smaller home health agencies.

CMS has launched preauthorization initiatives for other industries with high improper payment rates, including durable medical equipment providers and ambulance services, although some have raised concerns about the impact on patient care.

To learn more:
- read the PQHH letter
- here are the comments to the proposed rule

Related Articles:
CMS drafts new rules to limit home health fraud
New preauthorization rule targets DME fraud, improper payments
Feds dole out stiff penalties for home health fraud
Preauthorization programs have ill effects on patients and ambulance providers
CMS launches ambulance precertification program

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