By Kristin Easterling

(May 17, 2018)—The Centers for Medicare & Medicaid Services (CMS) issued new guidance on electronic visit verification (EVV), in accordance with section 12006(b) of the Cures Act. This section requires the Secretary of the Department of Health and Human Services (HHS) to collect and disseminate best practices for the training people who provide personal care services (PCS), home health care services (HHCS) or both, on the operation of EVV systems. EVV is a telephonic, mobile and computer-based system that documents the precise time and actions taken by agency caregivers in the home. CMS released a bulletin of strategies and best practices for implementing EVV, as well as an FAQ document for providers.

The new EVV expectations aim to address fraud, prevent improper payments and protect beneficiaries in Medicaid’s personal care services program. Some states have reported ongoing implementation challenges with EVV.

As states implement EVV, they will need to assess providers currently using their own systems, according to CMS. Vendor relationships will need to be evaluated, and EVV requirements defined. The ability of staff in Medicaid agencies to develop, implement and use the EVV system is also a consideration as rollout progresses. A pilot rollout will be needed in most cases.

Background
Under section 12006 of the Cures Act, all states and territories must require the use of EVV for home health and personal care services that require an in-home visit from a provider. States are required to implement EVV for PCS by January 1, 2019 and for HHCS by January 1, 2023.

CMS conducted a literature review of the current landscape of EVV, an outreach to Medicaid agencies, conducted state interviews and sought stakeholder feedback in order to present data on best practices. At the time of publication of the bulletin, Ohio was in the final phase of implementing EVV in compliance with the Cures Act, and four other states (Connecticut, Maryland, Texas and South Carolina) have varying degrees of compliance.

There are six verification criteria of EVV to meet:

  1. Service type
  2. Individual receiving the service
  3. Date of service
  4. Location of service delivery
  5. Individual providing the service
  6. Begin and end times of service

Models of EVV
There are five models of EVV that provide similar solutions but vary in respect to state involvement to vendor selection and management. They are:

  1. Provider Choice Model
  2. Managed Care Plan (MCP) Choice
  3. State Mandated In-house System
  4. State Mandated External Vendor
  5. Open Choice Model

States have flexibility in the plan they choose, as long as the plan meets statutory requirements.

To read more about each model, click here.

Addressing Concerns
The Cures Act does not include an exemption for remote and rural (frontier) areas, according to the released FAQ document. Internet access and cellular access in these areas can be spotty, making EVV difficult for providers. Evaluating the system that works best for each area of the state falls to the state.

As to privacy, The Cures Act does not require states to capture each location as the individual is moving throughout the community. Services either starting or stopping in the individual’s home are subject to EVV requirements, and capturing the location in which the service is started and stopped is sufficient for meeting the minimum requirements specified in the Cures Act.

CMS notes that states may choose to require more information as a factor to control for fraud, waste and abuse. There is no requirement to use global positioning services (GPS), but it is one approach for implementation of the EVV requirements. A common alternative to GPS is interactive voice response, which requires the caregiver to check in and out using a landline or cellular device located at the individual’s home.

Funding
Federal funding may be available for implementing these systems if operated by the state or by a contractor on behalf of the state. The state may apply for federal financial participation (FFP) for expenditures to receive 90 percent federal match for the design, development or installation of such a system, and 75 percent federal match for the operation and maintenance of the system. More information is available in the FAQ document.

Providers and state Medicaid representatives are encouraged to dig into the full CMS bulletin and FAQ document for all the details. Further information on EVV from Medicaid may be found here.