The Centers for Medicare & Medicaid Services (CMS) announced that it would postpone the initiation of the CMS Pre-Claim Review Demonstration for Home Health Services (the “Demonstration”) in Florida, which was scheduled to begin in October 2016. The start dates for Texas, Michigan and Massachusetts, which are also part of the Demonstration, have not yet been announced, but were originally scheduled to commence in Texas in 2016 and in Michigan and Massachusetts in 2017.
The Demonstration was first announced by CMS on June 8, 2016. It consists of a three-year Medicare pre-claim review demonstration for home health services in the states of Illinois, Florida, Texas, Michigan and Massachusetts. By implementing the Demonstration, CMS aims to protect the Medicare Trust Funds and taxpayer funds from fraud and inappropriate payments while providing the necessary care to Medicare beneficiaries in a timely manner. Pre-claim review is a method through which requests for provisional confirmation of coverage are submitted for evaluation before a final claim is submitted for payment.
The Demonstration began first in Illinois on August 3, 2016. However, based on early information, CMS believes that greater educational efforts are necessary before the Demonstration is implemented in the additional states. Educational efforts will focus on issues such as how to submit pre-claim review requests and documentation requirements. CMS will provide at least thirty (30) days’ notice on its website before implementing the Demonstration on any of the four aforementioned states. Once it is ready to begin re-implementing the Demonstration, CMS expects to stagger the start dates in the different states, beginning with Florida.