House members ask HHS to pull home health prior authorization plan

More than 100 members of the U.S. House of Representatives have lobbied the Department of Health and Human Services to withdraw its plans for a demonstration project that would require prior authorization for home healthcare services.

Under the proposal, if home healthcare companies provided services without prior authorization, they would receive an immediate penalty of 25 percent of their payment, even if the service was appropriate and necessary for the patient. The Centers for Medicare & Medicaid Services is proposing such criteria in five states--Michigan, Illinois, Florida, Massachusetts and Texas, AHA News Now reported.

The program is in response to concerns that there is widespread fraud inside the Medicare program, specifically regarding home healthcare services and durable medical equipment. The federal government secured convictions last year in a massive fraud scheme involving motorized wheelchairs.

The letter, sent to HHS Secretary Sylvia Mathews Burwell and acting CMS Administrator Andrew Slavitt, claims that prior authorization would interfere with the patient-physician relationship and ultimately limit access to home healthcare services. Instead, the lawmakers suggested a more focused approach on potential bad actors, as opposed to taking actions that would place a significant burden on innocent business operators, according to the letter.

As a result, the lawmakers who are on both sides of the aisle, asked HHS and CMS to withdraw the proposal.

There has always been tumult surrounding demonstration projects involving home health or related services. A successful demonstration project involving durable medical equipment drew grievances from mom-and-pop operators, claiming they could not compete with larger operators.

To learn more:
- read the AHA News Now article
- check out the letter to HHS (.pdf)