Home Health & Hospice Week

Register for Palmetto’s PCR educational sessions in Florida, Texas.

Illinois home health agencies are already suffering with an average of 80 percent of their Pre-Claim Review requests denied, and agencies in other states are scheduled to meet the same fate soon — unless the industry can stop it.

PCR is set to take effect in Florida Oct. 1 and Texas Dec. 1. HHH Medicare Administrative Contractor Palmetto GBA is partnering with state trade groups to hold a series of in-person educational conferences about the demonstration program in those states over the next three months.

But given PCR’s staggering denial statistics of around 80 percent thus far (see related story, p. 254), HHAs and their reps are trying to contain the pain before it spreads.

“Numerous congressional officials have communicated their concerns to the Centers for Medicare & Medicaid Services” about PCR, the National Association for Home Care & Hospice says in its member newsletter.

For example: Florida Senators Bill Nelson (D) and Marco Rubio (R) sent CMS Acting Administrator Andy Slavitt a Sept. 1 letter calling for PCR expansion into other states to be delayed until the demo’s impact in Illinois is evaluated — particularly access to care. If CMS does move ahead with PCR in

Florida, the senators urge a “scaled-down approach” — perhaps reviewing only a small sample of claims.

Don’t get your hopes up for a total reversal, though. “If history is a guide, CMS will continue to use this mechanism to reduce home healthcare spending until Congress forces them to find a better way,” observes attorney Bob Morgan with Much Shelist in Chicago.

“The option of a legislative fix exists, albeit with great difficulty in a year focused on the elections and backlogged work on the budget,” NAHC says.

The trade group notes that it is employing other methods, such as enlisting patient advocacy allies and researching a potential lawsuit, as ways to avoid the PCR train wreck in other states. But remember, “litigation is always a last resort” NAHC says. “Litigation needs support of evidence of harmful impact.

Unfortunately, that means that any lawsuit must wait for the harm to surface in order to present a compelling case in court.”

Note: To register for Palmetto’s PCR sessions in Florida, go to www.homecarefla.org/events/event_list.asp; in Texas, go to https://tahch.org/tahchorg/education/pcrworkshops.