Congress Inquires CMS to Scrap Prior Authorization for Home Health

Congress expects CMS will reconsider its intended demonstration for prior authorization for home health services.

A CMS proposal to need a prior authorization screening for every home health service would be an administrative nightmare and may produce hurdles to care for needy sufferers, a group of 116 lawmakers stated in a letter to CMS this week.

"This demonstration project enforces costs on sufferers, providers and taxpayers,” the letter stated. “Delaying patient care while waiting for CMS to pass home health services may put patient health in jeopardy and cause sufferers to stay in the hospital longer than necessary."

In the month of February 2016, CMS proposed a prior authorization demonstration program for Medicare home health services in the state of Florida, Texas, Illinois, Michigan, and Massachusetts. The announcement was involved in a Paperwork Reduction Act notice in the Federal Register. These states, excluding Massachusetts, are currently involved in the HHS/Department of Justice fraud enforcement program.