Home Health & Hospice Week

You’ll have only 30 days’ notice before program hits your state.

The adage “hope for the best but prepare for the worst” applies to the Pre-Claim Review demonstration’s newly announced delay.

The Centers for Medicare & Medicaid Services announced the pause Sept. 19, but did not set a new timeline for the resumption of the roll-out (see story, p. 270). Instead, CMS said it will provide 30 days’ notice via its website before implementing the program in the remaining demo states of Florida, Texas, Massachusetts, and Michigan.

National and state trade groups are cheering the delay, but warning demo state HHAs to stay alert.

“We do not know if this will be a short or long delay,” says Joy Cameron with the Visiting Nurse Associations of America. “CMS has not given us any indication of the duration of the pause.”

With a mere 30 days’ notice, CMS “can announce implementation is moving forward again,” Michigan HomeCare and Hospice Association head Barry Cargill warns members in a letter about the delay.

Remember: HHAs would love to see the program scrapped altogether. But “there has been an enormous investment already made by CMS and the MACs to hire and train hundreds of nurses to handle the volume of claims coming out of Florida” for review, points out Bobby Lolley with the Home Care Association of Florida. “Palmetto stated that those nurses have already been hired and trained, just waiting for it to begin here.”

Lolley does hope the program can be scaled back or targeted, instead of enforced across the board, he says.

Alternative: The HHS Office of Inspector General “has identified characteristics commonly found in fraud cases,” the National Association for Home Care & Hospice notes in its member newsletter.

“CMS should concentrate its resources on pursuing those outliers, instead of punishing hard-working and law-abiding home health agencies and their patients.”