Seema Verma
Statement Attributable to CMS Administrator Seema Verma
“CMS is committed to putting patients over paperwork and protecting taxpayer dollars. To achieve this vision, we must ensure that strengthened enforcement preserves beneficiaries’ choice of services and reduces provider burden.
We are continuing to expand implementation of the home health demonstration to providers in Texas to combat fraud and abuse. Providers can choose from three claims review options to ensure the right payments are made at the right time for essential home health services. We expect this demonstration to keep dollars in the Medicare program and away from unscrupulous providers.
We look forward to home health agencies across the Lone Star State being part of this important step in improving Medicare, protecting patients, and safeguarding taxpayer dollars.”
Background
The Centers for Medicare & Medicaid Services (CMS) is expanding the Review Choice Demonstration (RCD) for Home Health Services to Texas, continuing efforts to combat fraud, waste, and abuse within the home health benefit. While progress has been made, the Medicare home health benefit continues to experience high levels of improper payments, including fraud, waste, and abuse.
CMS’ Comprehensive Error Rate Testing (CERT) program, which estimates Medicare Fee for Service (FFS) improper payments, continues to estimate high rates of improper payments in the home health benefit. Improper payments are payments to providers for claims that should not have been made or payments on made in an incorrect amount.
The Fiscal Year 2019 home health improper payment rate was 12.1%, or $2.3 billion in projected improper payments. The RCD helps ensure that the right payments are made at the right time for home health services through either pre-claim or post payment review. The RCD protects Medicare funding from improper payments, reduces the number of Medicare appeals, and improves provider compliance with Medicare program requirements. This demonstration better positions CMS to identify and prevent fraud and safeguards taxpayer dollars while empowering patients and minimizing unnecessary provider burden. The demonstration also protects beneficiaries from harm by ensuring that services are delivered consistently by compliant home health agencies.
In response to stakeholder feedback, the demonstration incorporates flexibility and choice for providers as well as risk-based changes to reward providers demonstrating compliance with Medicare home health policies. HHAs can select from three initial choices: Pre-Claim Review, Post payment Review, or Minimal Post payment Review with a 25% Payment Reduction. HHAs that demonstrate compliance with Medicare rules will have additional choices, including relief from most reviews, except for a review of a small sample of claims.
The RCD started in Illinois in June 2019 and opened in Ohio in September 2019. The review choice selection period began in Texas on January 15, 2020 and continues through February 13, 2020, with the demonstration beginning on March 2, 2020. CMS anticipates beginning the demonstration in North Carolina and Florida on May 4, 2020. CMS will provide at least 60 days’ notice in advance of the demonstration starting in the remaining two states.
Join us! Please see more information at: https://go.cms.gov/homehealthRCD
Questions on the demonstration may be sent to CMS at: HomeHealthRCD@cms.hhs.gov