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News and Press: HCAF in the News

Saturday's Letters: Protect Home Care for Seniors

Monday, February 13, 2017   (0 Comments)
Posted by: Kyle Simon

By Kyle Simon, Special to the Tampa Bay Times

Last year, as part of its ongoing effort to reduce Medicare fraud and generate program savings, the federal Centers for Medicare and Medicaid Services launched a new regulatory requirement known as Pre-Claim Review for home health services. Five states were initially selected to try out the program, including Florida. The program is underway in Illinois and is set to begin in Florida on April 1.

Under Pre-Claim Review, a third-party contractor is required to decide whether doctor-prescribed home health care is "medically necessary" before Medicare will approve payment for a patient's care. Though originally intended to ensure that American tax dollars were put to good use, the program's rollout has been marred with problems.

Not only has Pre-Claim Review seemingly done nothing to address fraud, it has led to massive delays in home health care and a slew of improper denials that interfere in the delivery of timely care for older Americans. Since implemented in other parts of the country, technical failures and extra paperwork have taken clinicians away from patients to fulfill administrative requirements. Doctors, who are best equipped to make health care decisions, saw their own prescriptions overridden by third-party bureaucrats who have never had contact with their patients.

Nearly 350,000 Floridians depend on Medicare home health each year. It is a safe and effective means for patients to recover from illness and injury in the comfort of their own homes. It's also highly cost-effective compared to care provided in the hospital or skilled nursing setting, underscoring why Medicare should be expanding access to home health, not restricting it.

As a representative of Florida's home health agencies, I strongly urge our federal lawmakers to act immediately to protect seniors' home health care by asking Medicare to stop this flawed program from being implemented across our state.

The writer is director of government affairs and communications for the Home Care Association of Florida.

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