News: Budget Cuts, Therapy Caps, Opioid Crises & More - OptimaHCS -->


Top News of the Month: From Budget Cuts to the Therapy Caps, Opioid Crises and More

Posted on February 28, 2018 by & filed under Blog Posts, Clinical/Regulatory, Technology Trends

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Top News of the Month: From Budget Cuts to the Therapy Caps, Opioid Crises and More

The post-acute care industry has had a lot of news to contend with since the start of the year, including newly proposed budgets and bills. We’ve summarized a few of the top stories to keep you of abreast of the changes.

President Trump Unveils Budget, and Cuts Affect Post-Acute Services

On Feb. 12, President Trump unveiled the Fiscal Year 2019 budget proposal outlining his plans over the coming year. The administration proposed a handful of cuts to services in the post-acute sector, including home health, hospice, skilled nursing, therapy and more.

Budget proposals usually aren’t enacted. They simply represent an administration’s views and priorities. Even so, the Trump administration proposed nearly $236 billion in cuts to Medicare over a 10-year period, Forbes reported.

Most of the cuts would lower payments to providers, doctors and skilled nursing facilities. Additionally, the Trump Administration proposed eliminating cost-sharing for individuals with high prescription drug expenses, cutting funding for disability programs by 30% and eliminating key block grants some states rely on to fund senior programs.

Spending Bill Winners and Losers

Shortly before the Trump Administration unveiled its budget proposal, Congress sent President Trump a two-year budget bill that ended a brief government shutdown.

Home health payment reform was just one of several items in the spending bill. Given the scope of the new budget bill, there are a handful of winners and losers.


Patients and providers in remote areas: The budget deal includes funding for the “rural safeguard.” This 3% Medicare payment add-on has been around since 2000 and helps cover the costs associated with delivering home care services in remote locations.

Face-to-face (Providers): Many providers see existing face-to-face requirements as burdensome, so they stand to benefit from the change requiring the Centers for Medicare and Medicaid Services (CMS) to look at physician and HHA records for coverage eligibility.

Telehealth: Telehealth is a winner coming out of the budget deal because it will be expanded under Medicare.


Government-reimbursed home health providers: The budget introduced a new 30-day payment model for home health, starting in 2020. It will replace the current 60-day model. However, it remains to be seen how the new payment model will impact the industry.

In all likelihood, CMS will propose a slate of regulations pertaining to the new payment model sometime in the summer of 2018.

President Trump signs law that allows physician assistants to provide hospice care to Medicare patients

In early February, President Trump signed a new law — as part of the budget deal — that allows physician assistants to provide hospice care to terminally ill patients also on Medicare.

Previously, restrictions would have prevented PAs from providing hospice care to Medicare patients, forcing patients to choose between hospice or continued care. Come Jan. 1, 2019, that will no longer be the case. The change has been applauded by the American Academy of Physician Assistants.

“This new law will empower PAs to offer continuity of care at a time when patients and their families are most vulnerable,” said L. Gail Curtis, PA-C, MPAS, DFAAPA, president and chair of AAPA’s Board of Directors.

Therapy caps and thresholds

The budget deal contained some good news for therapy: Congress lifting Medicare limits on therapy. This change means millions of Medicare beneficiaries will now be able to better afford speech, occupational and physical therapy.

Payment caps had been in place for the last 20 years. Following President Trump’s signing of the budget bill, AARP lauded the move.

“Millions of vulnerable patients who need occupational, physical and speech-language therapy will now be protected from an arbitrary limit on how much Medicare will pay for needed therapy,” said Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer, in a press release.

However, the proposed new home health payment model, which would eliminate therapy thresholds as a factor for reimbursement, could be challenging for home health care providers. There is concern that this could disincentivize therapy for patient care in home care settings. The model still needs to be proposed by CMS, and the industry is currently in a wait and see mode.

New Kentucky legislation may regulate hospice disposal of prescription painkillers

A piece of legislation was introduced in the Kentucky House of Representatives that would have hospice providers develop policies to dispose of prescription painkillers after a patient’s death.

House Bill 148 would require hospice providers to reach an agreement with a patient that allows the provider to dispose of that patient’s medication following his or her death. Currently, unused medication is transferred to the patient’s estate. If an agreement can’t be reached, the hospice provider would need to notify local authorities, informing them of the painkillers.

Representative Addia Wuchner, the bill’s sponsor, said House Bill 148 is designed to curb the supply of opioid-based painkillers. Kentucky has been hit particularly hard by the ongoing opioid crisis.

The bill now moves to the Kentucky Senate and, if signed, Kentucky will join a growing number of states that are taking action to combat the opioid crises in hospice care. According to a 2017 Kaiser Health News report, “in the past three years, Ohio, Delaware, New Jersey and South Carolina have passed laws giving hospice staff authority to destroy unused drugs after patients die. Similar bills moved forward in Illinois, Wisconsin and Georgia this year.”

How your EMR provider can help

From payment models to new regulations, post-acute care providers will need to successfully navigate these changes while managing growth. Your EMR provider should be able to help you keep pace and stay compliant with regulatory expertise and through the technology itself—by continuously updating the software to ensure you’re prepared for whatever comes your way. To learn more, find out how Optima’s home care software or therapy software can help your organization.