In the twilight of the Obama era in December 2016, Congress passed the sweeping “21st Century Cures Act,” which pumped $6.3 billion into medical research and expedited the Food & Drug Administration’s approval process.
But tucked into the law is a little-known provision that is intended to protect Medicaid and Medicare against fraud but which healthcare providers for seniors and people with disabilities are worried may hamper their flexibility to provide care in the community while others fear a loss of privacy.
The act requires in-home and community care providers for these vulnerable groups to verify electronically when they start and end a service visit with a consumer-patient, and the system must be in place by the end of this year. The rationale is clear -- with a limited amount public dollars for services, the system uses technology to ensure that vendors are only billing for the hours and services that a client actually receives.
But Mindi Mitchell, the vice president of operations at Rise Services in Salem, said that the first states to go online have had problems in their implementation, particularly in Ohio, where consumers were given a modified smartphone to carry with them for their providers to sign in and sign out.
“If it’s implemented in too restrictive a way, it can limit how a person can receive services,” Mitchell told The Lund Report. “We don’t want it to feel institutional.”
Rise serves about 150 families in the mid-Willamette Valley that have members with intellectual or developmental disabilities. The organization serves these individuals throughout their lives, from little children to older adults, in private homes and five group homes. Rise was founded in 1987, as the state began to transition intellectually disabled people away from the Fairview Training Center and back into the general population.
Mitchell said she would prefer that her staff members simply sign in and out with an app on their smartphones, rather than Ohio’s choice to make the client carry around additional equipment.
The Oregon Department of Human Services already collects much of the data required by the new law in its eXPRS system with two big exceptions. Personal support workers do not enter their time when they arrive for service, and often only complete this data days later. They also do not enter the location where the services are given -- which may be in the public, at the library a, doctor’s office, grocery store or park, for example.
The GPS tracking seems to have set off the most alarm bells for consumers in Ohio, and the state’s two senators, Democrat Sherrod Brown and Republican Rob Portman, introduced a bill this month to delay the implementation of electronic visit verification until 2020 as these issues are addressed.
Oregon DHS plans to develop the upgrades to its system over the summer, test it in the fall and train and implement people next winter. The state could lose Medicaid matching funds if it does not have the new requirements online by Jan. 1.
In California, SEIU Local 2015 has taken a strong stance against electronic visit verification, arguing that there is no evidence of widespread Medicaid fraud and calling the provision “a last ditch attempt from vendors of EVV software to jam the Cures Act with mandatory electronic visit verification to secure a profit.”
Rise Services is working to influence rather than fight the new requirements, and are hoping for assistance from local U.S. Rep. Kurt Schrader to make sure their input is received by the Centers for Medicare & Medicaid Services.
Mitchell said CMS was offering Oregon DHS a great deal of flexibility, and there were five different models that the state could choose from to meet the requirements of the 21st Century Cures Act. Rise gave Schrader a plaque on Tuesday, thanking him for his support for the Medicaid program. The Democratic congressman serves on a key House committee and fought attempts to repeal and replace Obamacare and cut Medicaid.
Republican bills not only would have ended Medicaid coverage for about 400,000 poor, able-bodied adults in Oregon, but they proposed inflation caps on disability service providers, where labor costs are rising greater than inflation. Those caps would likely have led to service cuts for the traditional Medicaid population of disabled people and indigent senior citizens.
“Medicaid is so important for our population especially,” Mitchell said.
Reach Chris Gray at [email protected].
Note: A reference to a "patient" has been changed to "client," at the request of Rise Services.