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CMS’s proposed "Prior-Authorization" program would conduct audits before processing Medicare claims for home health services in Florida, Texas, Illinois, Michigan and Massachusetts. New York is not currently included in the demonstration, though it is very likely that the pilot will be extended to New York and many other states as well. There are multiple problems with this proposal. It would deny or delay services prospectively, putting patients in limbo. It would also increase costs as patients remain idle in more expensive settings (like hospitals) as they await determinations from third-party bureaucrats about whether they can receive care at home to recuperate safely in the community. The federal government already has post-payment audits in place to address Medicare integrity. But this disastrous prior-authorization proposal would subject all claims to prepayment analysis, regardless of risk, creating yet another access-to-care hurdle for beneficiaries who need — and are entitled to  services. HCA is asking Congress to voice objections to CMS officials. We need Congress to get CMS to rescind this overreaching, unprecedented threat to cost-effective Medicare home health services. 

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