Are You Compliant? New CURES Act Rules in Effect

Are You Compliant New CURES Act Rules in Effect

It’s official: more deadlines have passed for the 21st Century CURES Act, and providers are required to have these latest ones implemented. As a follow-up to our previous CURES Act blog post, we’ve compiled information for the most recent updates to keep you and your organization informed.  

Per section 12006 of the CURES act, the deadline for states to implement an electronic visit verification (EVV) system occurred on the first of January 2023. In addition, new HL7 FHIR API capability and other criteria are now required to be available as of the 31st of December 2022. If you’re still uncertain what this fully means for your organization or if you’re still working on implementing both requirements, don’t worry. Here are some key facts to guide your entire team.  

EVV Systems

The EVV systems clause of the 21st Century CURES Act states that all state Medicaid programs must implement an EVV system for personal care services and home health care services. Each state, including U.S. territories, must mandate this, while providers need to implement the system. Additionally, providers must document at-home healthcare services conducted for a patient using Medicaid or state-based waiver program.

Some states choose varying titles for personal care services or add them into other service definitions. That said, the Act makes clear that any service requiring an in-home visit and is included under the home health or personal care services categories on form CMS-64 must abide by the EVV systems clause. Take note that the Program of All-Inclusive Care for the Elderly (PACE) is considered a separate benefit of Medicaid, and thus is not included under this clause of the Act. 

As stated previously, an EVV system must be implemented for the listed services. However, the Act does not list a specific system to use. The only prerequisite is that whatever system chosen must be able to verify the following information for each at-home visit:  

  1. Type of service provided 
  2. Patient receiving the service 
  3. Date of the at-home service 
  4. Location of where the service was provided 
  5. Provider conducting the service 
  6. Time the service begins and ends 

HL7 FHIR API Capabilities

In addition to the EVV clause, there’s an additional clause requiring new HL7 FHIR capabilities. In short, the goal in requiring HL7 FHIR APIs is to ensure a seamless data transfer from provider to patient. To ensure your organization is fully compliant with this clause of the Act, review the latest information from HL7 FHIR. 

Penalties for CURES Act Noncompliance

Because the EVV clause must be enacted at the state level, any penalties for noncompliance fall on each state. If an EVV is not implemented, the state will experience a decrease in the Federal Medical Assistance Percentage (FMAP) rate. The requirement for states to implement an EVV for Personal Care Services went into effect in 2020. Additionally, from 2023 onward, the FMAP rate is reduced by one percent each year a state doesn’t have an EVV.

On the other hand, FMAP reductions for home health care services hadn’t begun until this year. Similar to personal care services, home health care services will experience the same FMAP reductions for each year of noncompliance by a state.

However, the CMS explains that noncompliant states can be exempt from FMAP reductions for 2023 in implementing an EVV for home health care services. For this to happen, the state must have made a good faith effort to comply with requirements. In this case, a good faith effort means that the state must have taken steps to adopt an EVV system and have encountered unavoidable system delays.

Moreover, the HL7 FHIR requirements are the sole responsibility of EHR companies. If an EHR has failed to meet compliance, the ONC will issue a certification ban. Providers have no responsibility for this requirement. However, failure on an EHR company’s part to remain compliant would prevent its customers from submitting MIPS data.

Key Dates for the CURES Act

In summary, most of the deadlines for the 21st Century CURES Act have already passed. With that said, one requirement remains for providers to implement. By December 31st of 2023, EHI export capability must be available. 

Have more questions around the CURES Act? Our EHR team is here to help.