The 21st Century Cures Act includes sweeping changes to funding biomedical research, approving drugs and medical devices, and improving mental health. Several of these changes have direct implications for the home care industry – from major new regulations on Medicaid reimbursements to more minor tweaks to the small business insurance market and hospital readmission penalties.
We’ve highlighted the major impacts the Cures Act is likely to have on your business, so you can be prepared for the changes coming your way.
As one of the largest pieces of health care-focused legislation, the Cures Act contains $6.3 billion in provisions to foster such health care modernizations as:
Of these changes, we believe four areas will have the biggest impact on the home care industry:
Let’s explore these changes and their implications for agencies further.
The dollar amount of improper Medicaid payments has more than doubled since 2013 — skyrocketing to $29.1 billion in fiscal 2015 from $14.4 billion in fiscal 2013. The Cures Act seeks to fight Medicaid fraud through two provisions: creating a centralized database of caregivers and implementing EVV systems to provide proof of services rendered.
Centralized Medicaid Database of Caregivers
A growth in Medicaid fraud has been an unintended consequence of the growth in home care services. Verifying caregiver credentials has remained an elusive challenge for CMS.
The Cures Act seeks to address the issue by creating a national, centralized database that will:
Potential Impact: With this database, states themselves would submit information received from providers upon caregiver enrollment. Currently, providers in most states are required to submit the caregiver’s name, specialty, date of birth, Social Security number, national provider identifier, federal taxpayer identification number, and the state license or certification number.
Providers will need to continue to either collect this information from their caregivers or require the caregivers to verify that they have submitted the data to the appropriate regulatory bodies.
It’s also noteworthy that many industry experts view registries as unnecessary for several reasons.
Not only are they not likely to improve access to home care, but registries would also add development and maintenance costs, could be an invasion of caregiver privacy, and could even promote an underground economy where consumers make cash arrangements directly with caregivers. Furthermore, EVV already addresses issues around the accuracy of care delivery and claims submissions.
EVV Requirements
As fraud in the home health industry escalates, agencies are facing increased scrutiny over their ability to verify services delivered in order to receive payment.
The Cures Act establishes new requirements for electronic visit verification (EVV) for Medicaid-covered personal and home health services, such as attendant services, in-home respite services and private-duty nursing.
Potential Impact: Mandated EVV can be viewed as either another regulatory hurdle to overcome – or an opportunity to improve operational efficiencies.
Instead of selecting a solution that merely meets the EVV mandate, agencies can derive more value from the change by choosing a comprehensive care delivery management solution that goes beyond EVV and enables caregivers and offices to communicate in real time, facilitates point-of-care documentation, and provides highly valuable information that sets the stage for better care and service delivery at a lower overall cost.
The Cures Act sets forth a new standard for judging hospitals with high patient readmission rates: CMS must now consider patients’ backgrounds when assessing hospital readmission penalties. This risk-adjustment approach may benefit so-called “safety net” hospitals, encouraging them to provide the right level of care for their most vulnerable patients.
Potential Impact: As penalties are eased for certain hospitals, they may be less focused on reducing readmissions and therefore less inclined to invest in home care services.
To counteract this possibility, home care agencies should be prepared to collect, analyze, and present comprehensive data showing their efficacy and cost benefit to hospitals. Integrated technology to analyze the delivery of care will make this data more all-inclusive and easier to collect.
Tucked in at the end of the Cures Act is a small provision for the Small Business Health care Relief Act (SBHRA) that may significantly affect workers who don’t receive health insurance through their employer.
The provision will allow small businesses (fewer than 50 employees) to reimburse workers for some out-of-pocket health care costs and premiums that workers pay for insurance obtained in the individual market.
Although the intention is to boost enrollment in ACA exchanges, some are worried about a rebound effect: Small businesses may now find there’s less incentive to directly offer insurance to their workers. This may have broad implications for the insurance market as a whole.
Potential Impact: If fewer businesses offer health coverage, more workers may obtain coverage through the individual market. Cost is often a major deciding factor for these individuals; therefore, they might choose to purchase less comprehensive coverage.
This narrow coverage may significantly restrict an individual’s access to home care agency services, making it difficult (or impossible) for agencies to reach everyone who can benefit from its services.
Curating, securing and sharing patient information adds significant value to the health care system by allowing all providers to gain a full and complete view of patients and their care.
Traditionally, EHRs have largely been standalone solutions serving a single health care organization — not records to be shared among providers. Because vendors use proprietary, nonstandard formats to record and store data, communication between systems has been impossible.
The Cures Act aims to drive interoperability by:
Potential Impact: With true interoperability, care coordination will become easier as the full constellation of caregivers will have improved access to each patient’s medical history and current treatment plans. This holistic, transparent patient view will facilitate greater efficiencies for home care agencies while simultaneously allowing a higher quality of care.
Interoperability will also raise data exchange expectations throughout the health care ecosystem; home care agencies must be prepared to provide more detailed information as well as to analyze a greater amount of information in a client’s medical record.
The most forward-thinking agencies will use this opportunity to implement best-in-class technologies across their business areas. It may take more than one supplier to build the infrastructure necessary to efficiently coordinate client care across teams, streamline processes, and improve both compliance and communication.
Undoubtedly, the Cures Act directives have immense potential to modernize and personalize health care over the long term. However, there is still quite a bit of uncertainty surrounding how the act will be implemented in the short term. The best advice is to stay informed and aware, so that course corrections can be made quickly should the need arise.
CellTrak offers unique solutions that can help you integrate the Cures Act changes into your agency’s daily operations and stay compliant in a cost-effective manner.
Please visit our extensive resource section to stay up-to-date on emerging and trending issues, such as choosing the right EVV solution.