Update on the Pre-Claim Review Demonstration (PCRD) for Home Health Services
LeadingAge NY continues to follow the latest developments on the Pre-Claim Review Demonstration for Home Health Services in Illinois. The Centers for Medicare and Medicaid Services (CMS) stated that as of Nov. 26th, 87 percent of pre-claim review requests in Illinois had received provisional affirmation, including both fully affirmed or partially affirmed decisions. CMS continues to provide a breakdown of fully affirmed decisions and partially affirmed decisions.
We continue to track the developments on the PCRD. As we have previously reported, PCRD is only operating in Illinois; CMS delayed implementation in four other states because of all the problems they encountered. There remains considerable pushback from the home care industry to eliminate this demonstration project in its entirety. There does appear to be more support for the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016, which would delay PCRD and require reports to Congress.
LeadingAge NY will continue to keep members posted on PCRD and the PUSH Act.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871