Making Sense of New CURES Act Regulations for Home Health
Before the end of his second term as President of the United States, Barack Obama signed the 21st Century CURES Act into law, bringing forth a wealth of new regulations that will impact the home health industry.
While the law made headlines for its wide support on Capitol Hill and focus on tackling the most deadly diseases through research funding, it also contained a few key provisions that will require home health care providers to update or invest in new technology. In addition, home health agencies with certain services will see reimbursement changes over the next few years.
Experts and organizations have gone through some of the headline changes coming as a result of the law, shedding more light on what the future may hold for agencies.
The CURES Act contains a new Medicaid requirement for mandatory use of Electronic Visit Verification (EVV), which allows nurses and home health aides to check in electronically through software apps or devices and record the exact date, time and location of a visit. Agencies and states will face a financial penalty for failing to implement EVV for personal care and home health care services for Medicaid beneficiaries.
The act adds a requirement but leaves states to decide their own implementation strategies. EVV is required to be in place by 2019 for personal care services and 2023 for home health services.
While many home health care companies already utilize EVV for their care staff as part of their daily routines and practice, there is little consistency across the industry, according to Tom Meyer, former New York State Acting Medicaid Inspector General and current chief program integrity offer of HHAeXchange, a home care software vendor.
“Home care is a vulnerable population,” Meyer told HHCN. “EVV is a great technology for creating a point of control and managing the situation. It’s very good that the [CURES] Act requires it.”
However, with states in charge of their own means to carry out this requirement, providers may have to opt into a state-run program, a limited number of vendor choices or a platform that requires integration of various EVV systems.
The bill noted that the government would fund 90% of the costs attributed to the design, development or installation of an EVV system and 75% for the operation and maintenance costs. The funding would go to the states to execute their compliance plans, but Meyer says how states implement the regulation needs more clarity.
“That, we fear, will push states toward more closed systems,” Meyer said.
The result could help combat fraud in home health with a more accountable and trackable system for home health services.
The CURES Act outlined several steps to expand telehealth to Medicare beneficiaries where it could have the greatest effect. The Centers for Medicare & Medicaid Services (CMS) is required to provide a report on the population of Medicare beneficiaries that could benefit most from telehealth services.
The Medicare Payment Advisory Commission (MedPAC)—the commission that provides recommendations to Congress on the Medicare prospective payment system (PPS)—will be required to submit a report on Medicare and private plans that cover telehealth services and Medicare fee-for-service can pay for these services.
The Act does not go much further in expanding telehealth, but the National Association for Home Care & Hospice called the roadmap “a good step.”
Infusion Reimbursement Changes
Another regulation that could impact home health is a modification to the reimbursement for infusion drugs. The provision aims to reimburse at a rate closer to the actual drug prices. This will eliminate or reduce any potential incentive to overprescribe certain drugs based on higher margins, according to a report from S&P Global Ratings.
The new reimbursement rate took effect January 1, 2017. Previously, Medicare reimbursed 95% of the average wholesale price (AWP) of infusion drugs, leaving high margins for certain products, according to S&P Global Ratings. The new reimbursement realigns this reimbursement by resetting the rate to the industry benchmark of average sale price (ASP) plus 6%. The new law also includes a provision to reimburse for the services of administering the care, which is set to begin in 2021.
Written by Amy Baxter