CMS Announces Pre-Claim Program Delayed in Florida

April 5, 2017


A day before the Pre-Claim Review Demonstration (PCRD) was scheduled to begin (on April 1, 2017) in the state of Florida, the program has been delayed, the Centers for Medicare and Medicaid Services (CMS) announced recently.

The delay could translate into substantial changes to the demonstration, including the possibility that it will become optional for home health participants.

“During the pause, home health claims can be submitted for payment and will be paid under normal processing rules,” CMS posted on their website. The agency announced that they would provide an update to providers through their website a minimum of 30 days ahead of any further development related to the demonstration. This announcement arrived on the same day the agency submitted a proposal to delay the effective date of the new home health Conditions of Participation (CoPs) by six months.

PCRD has become a source of controversy, with a delay in 2016. It has been proceeding in the state of Illinois since August 2016 and was initially scheduled to begin in Florida, Texas, Massachusetts and Michigan.

Various groups across the industry were thankful for the pause, as considerable efforts by lawmakers, homecare organizations and providers had been made to pause the program.

“We are incredibly pleased CMS listened to the concerns expressed by bipartisan lawmakers and home and home health stakeholders, and suspended the application of the demonstration,” said Keith Myers, Chairman for the Partnership for Quality Home Healthcare. “While the Partnership fully supports CMS’ intent to reduce waste, fraud and abuse within the Medicare home health benefit, the pre-claim review demonstration is not the right approach and we are grateful CMS has chosen to suspend the program while improvements are made, which we believe will be beneficial to providers, physicians and patients alike,” Myers added.

The National Association for Home Care & Hospice (NAHC) shared knowledge that the program will undergo substantial change. “In our meeting the CMS administrator, it was indicated that CMS will be reforming the PCRD demonstration,” the association announced in article to its members.

“I appreciate the administration taking our concerns into account, and I’m encouraged by the CMS’s decision to delay the Home Health Pre-Claim Review Demonstration from taking effect April 1st,” said Senator Marco Rubio (R-FL) in a state to HHCN. “It’s my hope this process ultimately results in a better program that more effectively targets fraud.