Administrative Relief in Response to the 2019-Novel Coronavirus (COVID-19) Pandemic: Pausing Home Health Review Choice Demonstration (RCD)

Published 06/03/2020

Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of COVID19, a national emergency exists nationwide.

Effective with claims submitted on or after March 29, 2020, Palmetto GBA, specifically Jurisdiction M MAC, paused certain operations for the Home Health Review Choice Demonstration. During this time, all Additional Documentation Requests (ADRs) will be suspended.

  • ADRs issued prior to March 29, 2020, will be released and processed as normal; providers should not respond to any pending claims as all claims will be released for relief efforts 
  • Providers may continue to submit pre-claim review (PCR) requests during the pause 
  • Claims that have received a provisional affirmative PCR decision and are submitted with an affirmed unique tracking number (UTN) will continue to be excluded from future medical review. Following the end of the public health emergency (PHE) for the COVID-19 pandemic, the MACs will conduct postpayment review on claims otherwise subject to the demonstration that were submitted and paid during the pause.

CMS has also issued FAQs related to this topic. Providers can access this information by clicking here (PDF, 54 KB). Providers are strongly encouraged to stay informed by reading the Palmetto GBA email updates.

Note: Providers and suppliers must resume compliance with normal Medicare fee-for-service rules and regulations as soon as they are able to do so and, in any event, the waivers or modifications a provider and supplier was operating under are no longer available after the termination of the emergency period.

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