Archive for October, 2016

October 5, 2016

Breaking News From HCAF


CLICK HERE to take action NOW!

Today, CMS released a small amount claims data from the ongoing Pre-Claim Review (PCR) Demonstration in Illinois.

Some items of note in the Illinois data:

  • As of week 8, 66% of PCR requests have received a provisional affirmation or partially affirmed decision.
  • As of week 8, the non-affirmation rate is 34%.
  • Click here to read all of the data and more PCR resources on HCAF’s website
Additionally, CMS indicates the top reasons for non-affirmation:
HCAF is working with our national partners and state associations to request more data through the Freedom of Information Act (FOIA). A FOIA request will help us gain far more data that providers, lawmakers and CMS need in order to truly know if the PCR Demonstration project is actually effective. PCR is absolutely not realistic in its current untargeted scope and more data will help us paint a better picture of the program’s future viability.

PCR began in Illinois on August 3, 2016. After our advocacy efforts, CMS earlier announced that they will not move forward with initiating the demonstration in Florida in October, but still continued with the program in Illinois.

We are sharing this data with Florida providers because this will help you prepare. PCR is delayed in our state but it’s not going away for good! CMS plans to release education on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation until they are ready to re-launch the program. CMS will undoubtedly move forward with PCR in Florida and will provide at least 30 days’ notice on their website prior to the beginning date. CMS has said that Florida will be the first state to start when they re-launch the program. 30 days is not enough time to prepare so please use this data coming out of Illinois to start re-organizing your agencies to ensure high affirmation rates when Pre-Claim Review does in fact come to our state.

We continue to advocate against Pre-Claim Review and we need your help to delay this program even longer and have a chance to permanently get rid of PCR. There is now legislation in the U.S. House of Representatives that would impose a 1 year delay. We need Florida lawmakers to sign-on as co-sponsors. Visit our Legislative Action Center to help us end PCR once and for all by writing to your lawmakers today! CLICK HERE to take action NOW!

**All content and images are credited and attributed to the Home Care Association of Florida.