WASHINGTON, D.C. – Today Congressmen Tom Price, M.D. (GA-06) and Jim McGovern (MA-02) issued the following statements upon the introduction of their bipartisan bill H.R. 6226, the Pre-Claims Undermine Seniors’ Health (PUSH) Act, to address a new initiative from the Centers for Medicare and Medicaid Services which impacts seniors’ access to home health care.
“Many seniors and sick patients rely on home health care, which is oftentimes the most clinically appropriate, cost effective setting for treatment,” said Congressman Tom Price, M.D. “CMS’s demonstration project is jeopardizing their safety by delaying or disrupting access to that care. Not only is this new system an entirely inefficient use of Medicare resources, it will also threaten access to home health services for thousands of seniors. The PUSH Act establishes a one-year moratorium on this harmful demonstration project to protect those who rely on home health care.”
“Home health care helps millions of American seniors live independently and get the care they need while living at home,” said Congressman Jim McGovern (MA-02). “I’m worried that CMS’s demonstration project will make it more difficult for those in need to get timely home health services. Our bipartisan bill requires a “pause” in the demo to allow CMS to re-evaluate the full impact of this initiative. I urge my colleagues on both sides of the aisle to support this essential bill when Congress returns in November.”
Today, nearly 3.5 million of our most vulnerable seniors use home health services for care, allowing them to live in the comfort of their own homes. Home health services are also a cost effective way to provide care for patients.
Recently, the Centers for Medicare and Medicaid Services (CMS) initiated an unprecedented demonstration project intended to help combat fraud and abuse. The demo requires home health agencies to submit full patient records on all cases for “pre-claim review,” or face a 25% payment penalty. It takes nearly an hour for a registered nurse or other provider to submit the required records, diverting providers from patient care. These reviews have rejected the vast majority of cases, ostensibly for minor paperwork deficiencies. As a result, some existing patients have terminated their care and other prospective patients have encountered delays and obstacles to treatment as home health agencies wait for an “affirmation” in their pre-claim reviews that will permit them to simply file a claim for payment. This demonstration project is creating barriers to quality health care and forcing providers to incur significant unnecessary burdens to support an overly broad demonstration that fails to effectively eliminate fraud.
While CMS has recently announced a delay of the expansion of the demo to provide time for an education effort in other states, the agency will resume the demo in future months. CMS must simply provide 30-day’s notice at any given time to initiate the demo in remaining states.
If signed into law, the Pre-Claims Undermine Seniors’ Health (PUSH) Act would impose a one-year moratorium on the demo across all states. The PUSH Act also requires CMS to report to Congress on the impact of the demo on patients, home health agencies, physicians, and Medicare spending, while equipping Congress with helpful information to more effectively combat fraud. This will remove barriers to home health care, establish efficiencies in how Medicare handles home health claims, and better determine how to effectively target fraud without disrupting or reducing access to care.
Click here to read the legislation.