AHA recommends CMS retool home health prior authorization proposal

The AHA today urged the Centers for Medicare & Medicaid Services to replace its proposed prior authorization demonstration for home health services with more targeted and proven fraud-fighting interventions. The CMS proposal would subject all HH services in Florida, Illinois, Massachusetts, Michigan and Texas to prior authorization or a 25% penalty. “We urge CMS to focus on interventions that target HH agencies with likely fraudulent practices, based on an analysis of Medicare claims,” wrote AHA Executive Vice President Tom Nickels. “Such an approach would be more effective than using an across-the-board prior authorization, which would burden the entire HH field in these states, as well as already-overloaded Medicare contractors. CMS also must include comprehensive protections for beneficiaries who would likely be affected by this policy, such as provisions to ensure timely prior authorization coverage decisions and beneficiary appeals – details of which are absent from this proposal.”