We move the intelligence of the system to the moment where care actually happens.
Cura OS enables safe, accountable community living by embedding plan-driven guidance directly into frontline care delivery — so safety is no longer confined to institutional settings.
Safer
Service delivery
Expanded
Community living
Sustainable
Cost structures
Clinical safety has always required licensed professionals at the point of care. Cura OS changes the equation: the need at the moment of care is not a license — it's the right guidance at the right moment. When that guidance exists at the point of service, the tradeoff between safety and community living disappears.
The Convergence
Three Forces.
One Infrastructure Answer.
CMS CRUSH Initiative
CMS has shifted Medicaid integrity strategy from retrospective claims recovery to real-time point-of-care prevention. States that cannot demonstrate real-time validation face compounding audit exposure.
CMS Access Rule
HCBS quality outcome requirements move from aspirational to mandatory. States must demonstrate services are delivered as authorized with documentation that survives federal audit. EVV confirms presence. It does not confirm service delivery.
The Rebalancing Mandate
Every state's rebalancing agenda depends on a commitment states cannot currently make with confidence: that HCBS placement is as reliable as institutional care. Cura OS closes that gap.
The Critical Distinction
EVV Confirms Attendance.
Cura OS Confirms Care.
Electronic Visit Verification
What states have today
Confirms caregiver clocked in at the location
Does not confirm any service was delivered
Records start time, end time, and GPS coordinates
Does not reference the individual's Plan of Care
Validates billing hours for claims submission
Does not validate service content or quality
The gap: EVV cannot answer whether the authorized service was actually delivered. It confirms a body in a room — not care in a home.
Plan-Driven Service Validation
What Cura OS adds
Validates each authorized service against the Plan of Care
Structured prompts tied to individual health profiles
Captures condition-specific clinical observations every shift
Respiratory, cardiovascular, pain, mental status, allergy checks
Generates audit-ready documentation before payment
Provides early-warning indicators for placement risk
The result: Real-time, auditable confirmation that every authorized service is delivered according to the Plan of Care — before payment, not 30–90 days after.
Real-World Evidence
What "Good — Because He's Smiling" Actually Costs
A 62-year-old Louisiana NOW waiver recipient with profound ID, asthma, and a severe shellfish allergy. Three months of progress notes. Zero condition-specific observations. Zero allergy checks. Every shift documented as "Good — because he's smiling."
This is not an outlier. Cura OS's Plan-Driven Service Validation closes this gap at the point of care — with structured wellness assessments, voice-guided clinical prompts, and timestamped medication verification.
See the Full EvidenceToday
With Cura OS
Wellness check
"Good — because he's smiling"
Structured assessment: respiratory, cardiovascular, pain, mental
Condition monitoring
"No issues today"
Voice-guided prompts: "Any wheezing or breathing changes?"
Medication
"I gave him his meds"
Timestamped verification: each medication by name + exact time
Two Markets, One Platform
Same Infrastructure.
Different Mandates.
HCBS serves two distinct populations through the same state Medicaid infrastructure. Cura OS's service validation platform operates across both, because the underlying accountability requirement is identical.
Aging, Adult HCBS &
Long-Term Services
The larger and faster-growing HCBS segment. Beneficiaries need sub-medical ADL assistance and situation monitoring. The Olmstead mandate requires deinstitutionalization, but states cannot make that commitment without proof that community placement is as reliable as institutional care.
IDD & Developmental
Disabilities
Where Cura OS was built and validated. The self-directed, consumer-driven model most closely tied to individual choice — delivered with integrity adequate to support complex medical condition management. Rate accountability, PERM compliance, and CRUSH alignment are the active policy drivers.
Fiscal Intermediaries & Self-Direction
Payment InfrastructureThe fastest-growing HCBS spending segment — with no real-time service validation layer. CRUSH creates direct exposure. Cura OS integrates with existing FI payment rails.
DetailsOne platform, two markets. The underlying accountability requirement is identical across every HCBS population — validated service delivery, before payment, against the Plan of Care.
Aging, LTSS & Personal Care Directors
Make the Rebalancing Commitment with Confidence
The cost differential is well documented — a nursing facility bed costs $85,000–$100,000 annually; a comparable HCBS slot costs $25,000–$40,000. The barrier to realizing that savings at scale is not funding. It is the absence of real-time service reliability confirmation.
Cura OS's Plan-Driven Service Validation provides that confirmation, against the individual's Plan of Care, at the moment of service delivery.
25–35% reduction in avoidable emergency department visits
Real-time HCBS quality documentation for Access Rule compliance
2–4 week advance warning before placement risk escalation
LTPCS and PCA service validation at point of delivery
Olmstead compliance documentation for community placement decisions
Rebalancing & long-term services strategy
Key Deliverables
- 1Plan-Driven Service Validation for ADL and situation monitoring
- 2Olmstead-compliant community placement reliability confirmation
- 3Access Rule quality outcome documentation
- 4Placement risk early-warning system
- 5Sub-medical service validation with clinical-grade integrity
Relevant national networks:
Key Deliverables
- 1Rate-to-outcome accountability documentation
- 2PERM error prevention at point of care
- 3CRUSH-compliant validation infrastructure
- 4Consumer-directed service validation with choice preservation
- 5Multi-agency deployment proof across Louisiana
Relevant national networks:
State Directors of Developmental Disabilities
Rate Accountability That Validates Your Investment
Actuarial rate studies create a corresponding accountability obligation. Retrospective claims data cannot answer whether higher rates produced better outcomes. Cura OS answers it in real time, from the point of care, across every authorized service.
Cura OS's PERM error prevention converts retrospective audit liability into proactive quality documentation.
Plan-Driven Service Validation across all authorized services
Real-time PERM compliance documentation — audit-ready from day one
CRUSH-aligned service delivery confirmation before payment processing
Louisiana: 35+ agencies across all regions — active proof point now
IDD rate accountability & CRUSH alignment
Fiscal Intermediaries & Self-Direction Programs
Close the Accountability Gap Before CMS Does
Fiscal intermediaries are the payment infrastructure for the fastest-growing segment of HCBS spending — and self-direction programs currently have no real-time service delivery confirmation layer.
CRUSH creates direct exposure for organizations processing Medicaid payments without point-of-care validation. The gap is structural, not operational. Cura OS's validation infrastructure integrates with existing FI payment rails.
CRUSH-compliant service validation for participant-directed payments
Real-time participant service confirmation — not EVV, service validation
Access Rule quality outcome documentation for self-direction programs
Integration with existing FI infrastructure — no participant disruption
Fiscal intermediary & self-direction accountability
Key Deliverables
- 1CRUSH-compliant accountability layer for FI payment rails
- 2Participant-directed service validation at point of care
- 3Self-direction quality outcome documentation
- 4Zero-disruption integration with existing FMS systems
- 5Standard-setting position before CMS mandates specifics
Relevant national networks:
Proof of Concept
Built for the Hardest Case.
Designed for Every State.
IDD waiver populations are the most complex, highest-acuity, most federally scrutinized cohort in HCBS. If the platform holds here — across population types, care settings, and regulatory environments — it holds for any HCBS population in any state.
Cross-population, production-grade operating proof — IDD, aging, and personal care on a single shared infrastructure
Not a single-population pilot. Not a proof-of-concept requiring reengineering at scale. A platform tested across the full HCBS population spectrum — with the operational track record to demonstrate it.
500,000+ structured point-of-care service records — the largest HCBS care delivery dataset of its kind
Every record captured at the moment of service delivery, not reconstructed from memory or billing codes. The empirical foundation for predictive risk scoring, outcome validation, and CRUSH-aligned fraud detection.
Built by practitioners. Funded by the community it serves.
Cura OS was designed by career HCBS experts, providers, and case management organizations — and funded by mission-aligned capital from within that same community. The platform reflects operational reality, not theoretical architecture.
HCBS improper payment rates run 8–15% of total program spend nationally
States validate attendance. They do not validate care. Cura OS confirms service delivery against the Plan of Care before payment — converting post-audit liability into pre-payment accountability at any program scale.
Common Questions
What State Leaders Ask First
Clinical safety. Community Independence. Fiscal Integrity.
State directors, MCO partners, fiscal intermediaries, and federal contacts engaged with HCBS transformation are invited to connect directly with the Cura OS leadership team.
Looking for a printable overview? View the executive brief →