U.S. House Members Ask CMS to Withdraw Proposal for Prior Authorization in Home Health Care

This week, over 100 members of the U.S. House of Representatives wrote to the Centers for Medicare & Medicaid Services (CMS) asking the agency to withdraw a proposal for a demonstration project to test prior authorization requirements in home health care. Home health care services include home-based skilled nursing and therapy care for people with Medicare who are homebound, meaning they are unable to leave their home without difficulty.

In its proposal, CMS cites reports of improper payments for home health care and the possibility of fraud as reasons for proposing a demonstration to require the use of prior authorization in select states. Under the proposal, certified Medicare home health agencies would be required to submit documentation prior to delivering services instead of with their submitted claims.

The letter echoes some of the concerns raised by Medicare Rights in formal comments, which also called for CMS to withdraw the proposal. Primarily, we expressed concern that a prior authorization requirement may lead to unnecessary delays in accessing needed services.

Read the letter: