Home Health & Hospice Week

Which state will be next?

Florida home health agencies’ hopes for a Pre-Claim Review demonstration reprieve under the Trump administration have so far come to naught, with the start date mere weeks away.

Reminder: Since now-confirmed Health & Human Services Secretary Tom Price proved an anti-PCR ally while in Congress — introducing a bill to pause the program for further evaluation (see Eli’s HCW, Vol. XXV, No. 36) — HHAs were hoping to see program expansion halted when he was confirmed. Providers even wished for a complete repeal of the program.

Florida lawmakers gave the effort a boost with a Feb. 27 letter asking Sec. Price to consider an “alternative approach” to achieve fraud-fighting goals. PCR’s “current parameters are too broad to reduce fraud and improper payment rates,” the letter says.

Implementing PCR in Florida is “inappropriate” without major changes to the program, insists the letter signed by Florida senators Marco Rubio (R) and Bill Nelson (D), as well as 25 House members from the state. “We ask for the agency to replace PCRD with a more effective program integrity initiative that better targets fraud,” the lawmakers tell Price.

But HHS and the Centers for Medicare & Medicaid Services haven’t responded to the missive, so Florida agencies had better make sure they are up to the PCR task by the time the deadline hits. (For PCR prep advice, see Eli’s HCW, Vol. XXVI, No. 1.)

Resource #1: For some last-minute overview and procedural information, you can attend a PCR workshop offered by HHH Medicare Administrative Contractor CGS and Kindred at Home (formerly Gentiva) in Florida in late March. See the locations, dates and times, as well as links to register, at http://cgsmedicare.com/hhh/pubs/news/2017/0317/cope2319.html.

Resource #2: You can request individual clinical education from the MAC via its PCR email address at J15HHPRECLAIMREVIEW@cgsadmin.com, the MAC says on its website. That email address wasn’t functioning correctly from Feb. 27 through March 3, so if you sent questions or requests on those dates you should resend, the MAC advises.

Meanwhile, PCR in Illinois continues to operate. The Centers for Medicare & Medicaid Services appears to have ceased posting affirmation rates on its PCR website. In the last rate post on Jan. 20, CMS released a 91.7 percent provisional affirmation rate for Illinois PCR requests, including both fully affirmed and partially affirmed decisions.

And HHAs in the remaining states originally targeted for the PCR demo — Texas, Massachusetts, and Michigan — remain anxiously on watch for news of PCR start dates for their states. Since CMS gave more than 90 days’ notice before the Florida start date, providers in the remaining three states are hopeful they will get relatively lengthy lead time notifications as well.