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  • CMS Puts the Brakes on Unpopular 'Pre-Claim' Demonstration, Delays Conditions of Participation Update for Home Health

    In brief:

    • CMS is pausing a plan to try out a pre-claim review system for HHAs in 5 states.
    • The demonstration began in Illinois in August, 2016, and was supposed to be rolled out to Florida on April 1, 2017, followed by Texas, Michigan, and Massachusetts later in the year.
    • CMS now says the rollout won't happen in Florida, and it has suspended the program in Illinois for 30 days.
    • No pre-claim reviews will be accepted; claims will be dealt with "under normal processing rules" during the hold.
    • The suspension may signal a major shift in direction for the program including a possible changeover to a more targeted and/or voluntary system.
    • CMS has also delayed implementation of a revised rule that would have updated the minimum standards for HHAs that serve Medicare and Medicaid beneficiaries, moving back the effective date from July 13, 2017, to January 13, 2018.

    Good news for home health agencies (HHAs) and the physical therapists who work in those settings: the Centers for Medicare and Medicaid Services (CMS) is suspending its plans to expand a required pre-claim review process and is putting its sole demonstration on hold in Illinois for at least 30 days. The agency has also decided to hold off on implementing revisions to conditions of participation for HHAs.

    The announcement from CMS arrived just as the agency was scheduled to include Florida as the second state in a 5-state audition of a system requiring HHAs to submit supporting documentation for services while beneficiaries are receiving care. The proposal was largely opposed by HHA organizations, who view the requirement as an excessive administrative burden. CMS announced the suspension on March 31, 1 day before HHAs in Florida were set to begin the pre-claim demonstration.

    Although the demonstration in Illinois is currently on a 30-day hold, according to Home Health Care News, "the pause could preface major changes to the demonstration, including the possibility it will become optional for home health participants, one major industry association revealed."

    In a statement released March 31, CMS said it will not accept any pre-claim review requests, and "during this pause, home health claims can be submitted for payment and will be paid under normal claim processing rules." CMS will notify providers of its new direction in the next few weeks, before the 30-day hold in Illinois has expired.

    On the same day, CMS announced that its revision to the HHA participation rule—the first HHA participation rule revision in more than 20 years—will also be put on hold for at least 6 months. Originally set to begin on July 13, the updated minimum standards for participation included requirements that CMS hopes will strengthen patient rights, encourage more effective communication between patients and caregivers, and result in better outcomes reporting. According to CMS, HHAs expressed concerns that they didn't have enough time to prepare for the changes.

    Implementation of the new rule has been moved back to January 13, 2018, with the phase-in date for those requirements pushed back to July 13, 2018.

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