Federal lawmakers from Florida are asking the Trump administration to junk a planned three-year demonstration in which beneficiaries need to get prior approval before they get home health services.
The demonstration is taking place in Florida, Illinois, Massachusetts, Michigan and Texas—states that are all flagged by the CMS as having high levels of improper payments.
The pilot allows Medicare beneficiaries to immediately receive home health services once prescribed by physicians. But the home health agencies must submit supporting written evidence earlier than they normally would. Medicare reviews the paperwork and issues a decision within 10 days. If a claim is ultimately rejected, the agency can appeal.
In Florida, the demonstration was delayed from its initial start date of October 2016 to April 2017. U.S. Sens. Bill Nelson and Marco Rubio, who represent Florida say it was delayed after Illinois residents encountered problems with access to care problems.
“We believe that without meaningful changes to the program to ensure it appropriately detects fraud without jeopardizing seniors' access to home health care, it is inappropriate to implement the [pilot] in Florida,” a letter addressed to HHS Secretary Tom Price said. Home health services are now utilized by 3.5 million seniors and people with disabilities on Medicare in the state.
Price has promised to cut Medicare spending and given the high improper payment rates in the pilot states, it's unlikely he'll cancel the program.
In 2015, 59% of home healthcare payments, or more than $9 billion, were “improper.” The improper payment rate was 17.3% or $3 billion in 2013.
An improper payment can occur when funds go to the wrong recipient, the right recipient receives the incorrect amount of funds, documentation is not available to support a payment or the recipient uses funds in an improper manner. The tally includes fraudulent claims but is not a measure of fraud.