With only a few weeks left in office, President Barack Obama signed into law last month one of the most sweeping pieces of health care legislation since the Affordable Care Act. Collectively known as the 21st Century Cures Act, this bill — which came in at over 1,000 pages — calls for more than $6 billion in spending over the next 10 years, and includes provisions for everything from expanding medical research for diseases like cancer and Alzheimer’s to speeding up the FDA approval process for new treatments and medical devices.
Also included in the new law are a number of provisions that will impact home health care.
Changes to Moratoria
For several years now, CMS has imposed moratoria on new Medicare-approved home health agencies in Chicago, Dallas, Detroit, Fort Lauderdale, Houston, and Miami as a means of curbing fraud. However, because the moratoria focused on the actual physical location of the agency, and not the patients themselves, a number of new agencies were able to open outside of the moratorium area, and still serve patients in those areas. This “bricks and mortar” approach has been criticized by industry groups as ineffective, since home health is more about where a patient is located, not the office. Therefore, CMS extended the prohibition on new agencies to cover the entire state (Illinois, Florida, Texas, and Michigan) to prevent such workarounds, and proposed to modify the regulations to apply to the actual location of the patient, not the office.
The CURES Act takes that prohibition one step further, and denies newly enrolled providers in those states Medicare payments for services provided. It’s expected that this provision will save nearly $11 million through 2026. New agencies can open in these states in the meantime; however, they will not be approved for Medicare or receive Medicare reimbursements.
Electronic Visit Verification Now Mandatory
In another effort to curb fraud and abuse, the CURES Act includes a provision requiring electronic visit verification for personal care and home health services provided under state Medicaid programs. The legislation does not specify how states must implement the EVV requirement beyond providing basic standards for compliance. Among the potential options for EVV include using an independent visit verification provider directly connected to agency management software, a state-run EVV system, or another open-platform model that integrates multiple EVV suppliers. Some states, including Texas, have already implemented EVV for time and attendance among Medicaid home health and personal care providers, and can serve as a model for other states. Under the new rules, states that do not comply will face financial penalties.
New Home Infusion Therapy Benefit
Medicare has not covered home infusion therapy as a standalone benefit since 1989, when the Catastrophic Coverage Act was repealed. Under the CURES Act, that benefit will return in 2021, potentially saving Medicare $371 million in the first five years while increasing access to home infusion therapies.
Under the provisions of the act, home infusion therapy will require a plan of care developed by a physician, nurse practitioner or physician assistant, and for the services to be provided by a pharmacy, physician, or other provider of services, including a home health or hospice agency. The bill requires Medicare beneficiaries to pay a mandatory 20 percent co-pay for these services, and excludes the term “home infusion therapy” from the definition of “home health services.”
Expansion of Telehealth Services Imminent
Over the last few years, several bills before Congress have sought to increase access to telehealth services among various populations. Current laws present significant obstacles to the widespread expansion of telehealth, but Section 4013 of the CURES Act indicates that there are inroads being made in wider expansion of telehealth. The new law requires 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.”
Among the information to be included in the report includes details on ongoing telehealth demonstration projects, information about the types of services that are most suitable for telehealth, and an exploration of the barriers to the expansion of telehealth under current Medicare regulations. In addition, the new bill calls for a MedPAC report on what Medicare and private plans cover on telehealth services, and research into potential Medicare changes that will allow for the inclusion of telehealth in the Medicare fee-for-service program.
While the provisions of the CURES Act do not make significant changes to the availability of telehealth services in the immediate short term, they do indicate that Congress is moving in the direction of accepting and expanding access to this form of health care delivery.
While the 21st Century CURES Act makes some important changes to the delivery of home health care services, there are still many initiatives that are under consideration and reforms to be made. Stay tuned for more information in the coming months. In the meantime, visit Complia Health’s resources page to learn more about tools and software that can help your agency move forward and meet the challenges of the modern health care landscape.