PAR Mail 2018-081 | May 10, 2018
Medicaid Turns To Electronic Visit Verification
A January 1, 2019 compliance mandate, within the 21st Century Cures Act, enacted in December 2016, is approaching next year for many Medicaid funded programs with a particular emphasis on home health care. The Act calls upon states to implement  electronic visit verification (EVV)  systems and allows the Center for Medicare and Medicaid Services (CMS) to impose penalties (reduced federal Medicaid funding) upon individual states for non compliance beginning in 2019.

Of concern to both the state and providers is understanding the extent of the law as described in the final enacted law: ( Sec. 12006) Federal payment under Medicaid for in-home personal care services or home health care services is reduced for states that do not require the use of an electronic visit verification system for such services, effective January 1, 2019. The CMS must pay a specified share of state expenditures attributable to such a system.
In PA, ODP is looking to CMS for clarification with regards to how EVV may impact ID/A services and supports. In a discussion earlier this week with Deputy Secretary Nancy Thaler, she noted that the department does not want to define the required services any broader than the statute requires. Nancy noted that the department "is working aggressively through our associations and directly with CMS to get definitive guidance. (See NASDDDS story below)

EVV systems are believed to ensure accuracy in reporting and fraud prevention through the use of GPS or smart phone with caller-ID systems that can with minimum effort report to agencies and funders:

  • the type of service being provided
  • the service recipient
  • the time and date of service
  • the location of the service
  • the duration of the service
  • the individual person providing the service

Individual states are implementing EVV independent of each other relying upon working with stakeholder community members to design the best system that will work effectively within each state.

On May 1, 2018, The National Association of States United for Aging and Disabilities released a detailed explanation of the history and requirements of EVV.
In PA, the Department of Human Services (DHS) and the Office of Developmental Programs are working with stakeholders to inform the Commonwealth of specific needs to be built into the PA system.

DHS recently sent out an EVV update and survey request to providers with the following clarifying information:
The 21 st  Century Cures Act requires electronic visit verification (EVV) systems for Medicaid-funded personal care services (PCS) and home health care services.
What is considered PCS?
The Centers for Medicare & Medicaid Services (CMS) states that PCS consists of services supporting activities of daily living (ADL), such as movement, bathing, toileting, transferring, and personal hygiene or offers support for instrumental activities of daily living (IADL), such as meal preparation, money management, shopping, and telephone use. For more information on the EVV requirement for PCS,  click here . We anticipate additional guidance in the future from CMS on the requirements for EVV.
What is PA’s plan for complying with this requirement?
EVV use for PCS must be implemented by January 1, 2019, and home health by January 1, 2023. The Department of Human Services (DHS) received stakeholder input from beneficiaries, family caregivers, provider agencies, and other stakeholders on the current use of EVV in the Commonwealth and the impact of EVV implementation. This process showed that many providers already use an EVV system and DHS needs to utilize an open system that can compile data from those existing systems. To comply with the EVV requirement, DHS will use a two-phased approach.
Short Term:  DHS will use the existing PROMISE fiscal agent contract with DXC to comply with the federal requirement for EVV by January 1, 2019. This will be an open system that will receive information from existing EVV systems being used by providers and will provide EVV for PCS providers who do not have their own system.
Long Term:  DHS wants to have a better understanding of what providers are currently using for EVV and which providers do not currently have an EVV. PCS providers should complete the ( recent ) EVV survey. DHS also recently released a Request for Information (RFI) directed at EVV vendors. This provider survey and the RFI will give DHS an understanding of the full capabilities of EVV systems and the needs of providers. This information will inform DHS’s next steps with the possibility of a future procurement. The RFI can be found by clicking  here .
EVV Implementation Timelines & Extent Worry Some
ANCOR and State DD Directors Ask CMS for Better Clarification and More Guidance

ANCOR, the national ID/A provider association met this past month with CMS officials and report the following:

  • ANCOR urged CMS to consider the significant consequences of an overly broad application of EVV requirements, citing congressional intent and providing examples of why EVV would be inappropriately applied to I/DD services.
  • ANCOR learned that CMS seems to feel obligated to enforce a broader definition of the EVV requirements based on the agency's interpretation of statutory language, revealing the need for our continued commitment to advocacy on this issue.
  • ANCOR discerned that CMS' EVV guidance is likely to come in the form of two documents to be released in the coming weeks aimed at striking a balance between concerns over coverage and cost
  • ANCOR is asking members to email your members of Congress to tell them to stop the unintended consequences of EVV.

In early April, the National Association of State Directors of Developmental Disabilities Services (NASDDDS) urged CMS to issue further details and warned the federal agency that the approaching January 1, 2019 implementation date may be problematic.

The NASDDDS letter cited the following concerns:

  • clarification regarding the service threshold for inclusion into EVV requirements
  • clarification regarding how in home services provided as incidental to another service provided by the state may be impacted
  • clarification as to whether 24 hour settings may be impacted by EVV

Stakeholders are optimistic that further clarification will be forthcoming from CMS.

PAR Associate Business Members Offer Technical Expertise on EVV
in alphabetical order:
for information: Jim Butz, 212-780-1450
for information:
Carolyn Dingee, 301-228-2105
for more information:
Dennis Dicker
for information: Michelle Saunders, 312-720-0305
for info: David Klements