A bill that was passed by the House of Representatives last week, if passed by the Senate, will have an impact on several areas of the home health and hospice industry.
The 21st Century CURES Act is a combination of the original CURES legislation, which was intended to make the FDA drug review process more efficient, and a bill on mental health reform that was previously passed by the House.
There are four sections of the bill that will affect home care, which were described by the National Association for Home Care & Hospice (NAHC) in an online post Thursday. These parts of the bill include the use of telehealth services, Medicare coverage for home infusion therapy, mandatory use of electronic visit verification and a new moratoria.
The telehealth provisions of the CURES bill require CMS to provide a report on the populations of Medicare beneficiaries “whose care may be improved most in terms of quality and efficiency by the expansion … of telehealth services,” according to the bill.
The CMS report also must include information on any ongoing telehealth demonstration projects, the types of services that might be suitable for the use of telehealth and an explanation of barriers that are currently being faced regarding telehealth under current Medicare laws, according to NAHC.
“This provision is a clear indication that significant inroads have been made in establishing the value of telehealth,” NAHC said. “While it does not get us to where we should be, it is a good step in that direction.”
NAHC raises the question of if this provision goes far enough. The bill says that eligible originating sites for telehealth should be expanded, but it doesn’t explicitly state that the home should be one of those sites.
In terms of home infusion therapy, the bill would include a new home infusion therapy benefit to begin in 2021. Since the 1989 repeal of the Catastrophic Coverage Act, home infusion therapy has not been covered by Medicare as a stand-alone benefit. It is estimated that the new benefit of coverage will save Medicare $372 million by 2026.
The new benefit will require a plan of care by a physician, nurse practitioner or physician assistant as well as requiring a pharmacy, physician, or other provider of services, which includes a home health or hospice agency, to provide the home infusion therapy.
The other provisions regarding home infusion therapy in the bill include a mandatory 20% copay for home infusion therapy by Medicare beneficiaries as well as the exclusion of the term “home infusion therapy” from the definition of “home health services.”
NAHC shows some concern over this part of the bill and worries it won’t help expand access to home infusion therapy. This is in part because currently home infusion services can be covered under the home health Medicare benefit but that is not the case under the new bill. Under the new definition, it’s possible that a patient could lose access to home health aide services currently being provided in conjunction with home infusion.
Another aspect of the bill involves Medicaid electronic visit verification. The provision will require state Medicaid programs to implement an electronic visit verification for personal care and home health care services. If the states do not comply, they will face financial penalties, NAHC’s post said.
The last provision of the CURES legislation that relates to home care and hospice is a prohibition for payment and services given by newly enrolled providers. This particular provision is expected to save $11 million through 2026.
CMS has implemented a moratoria on new providers in several states as a way of curbing home health fraud. But because the current moratoria is based on where an agency’s office is located, some providers have set up shop outside the moratoria area yet provide care within it.
“This reform is intended to address the work-around that some providers and suppliers found with current moratoria that are focused on the location of the provider/supplier rather than the location of the service,” NAHC said in the press release. “NAHC had long been critical of the “bricks and mortar” approach taken by CMS on the application of moratoria given that home health services is about the patient location, not the office site.”
The Senate is expected to pass the 21st Century CURES bill before the end of the year.
Written by Alana Stramowski