Electronic visit verification (EVV) will be required for Medicaid personal care services (PCS) effective January 1, 2019 and home health services on January 1, 2023. It is important that EVV systems in self-direction programs meet the unique needs of self-directed services and the people who use them, which are often different from traditional personal care services.
Applied Self-Direction has produced several EVV resources, including many member-only resources. This webapge is designed to be your one-stop location for information and resources about the EVV and its impact on self-direction programs. More resources will be added as they are developed.
The 21st Century Cures Act
The 21st Century Cures Act, signed into law on December 13, 2016, provides funding for the National Institutes of Health, modifies the Food and Drug Administration (FDA) drug approval process, provides targeted funding for research on brain diseases, and strengthens mental health parity regulations. Included in the law are the requirements for Electronic Visit Verification (EVV) for personal care services and home health services under Medicaid.
States who have not implemented EVV for Medicaid personal care services by January 1, 2019 are at risk of a reduction in their Federal Medical Assistance Percentage (FMAP). The deadline for Medicaid home health services is January 1, 2023. The reductions in reimbursement for personal care services and home health services start at 0.25% for the first two years, and increase by 0.25% each year for a maximum reduction of 1%.
States are required to develop a plan for implementation in consultation with key stakeholders, including personal care and home health service providers, service recipients, their families and caregivers, and individuals providing the services. The EVV system should be minimally burdensome, comply with HIPAA privacy and security laws, and take into consideration current EVV systems in use in the state.
The Cures Act does not mandate any particular EVV system, but requires every implemented system to include verification of following key data elements:
- The type of service performed,
- The individual receiving the service,
- The date of the service,
- The location of the service,
- The individual providing the service, and
- The time the service begins and ends.
Services that fall under the EVV requirements include all Medicaid funded personal care services and home health care services, either provided under a state plan or waiver. This would include Home and Community-Based Services (HCBS).
The Act requires that the Secretary of Health and Human Services, through the Centers for Medicare and Medicaid Services (CMS), provide states with information on best practices for training individuals who provide personal care or home health services. Training should include the use of the EVV system and the prevention of fraud, waste, and abuse. Best practices should also include proven strategies for providing information to individuals receiving services and their family caregivers related to the prevention of fraud.
States may receive federal funding for 90% of the cost of the design, development and implementation of an EVV system. In addition, states may receive up to 75% of the cost for ongoing operation and maintenance. In order to receive this federal support, the EVV system must be operated by the state or a contractor on behalf of the state.
Personal Care Services
Electronic visit verification (EVV) will be required for Medicaid personal care services (PCS) effective January 1, 2019. This member-only resource provides a definition of PCS, as well as other key concepts related to EVV implementation.
Directory of EVV Vendors Interested in Serving Self-Direction Programs: In January 2018, Applied Self-Direction released a Request for Information (RFI) to identify EVV vendors interested in serving self-direction programs. It is important that EVV systems in self-direction programs meet the unique needs of self-directed services and the people who use them, which are often different from traditional personal care services. The Directory of Electronic Visit Verification (EVV) Vendors Interested in Serving Self-Direction Programs is based on the RFI responses.
Applied Self-Direction does not endorse any particular EVV provider or solution.
Questions to Ask EVV Vendors
Questions to Ask EVV Vendors: This member only resource can be used as a starting point in identifying an EVV solution for your particular situation. The questions focus on specific characteristics of self-direction programs, such as the need for participant-employers to verify hours worked, and the importance of flexibility in scheduling. The resource is available as a Word document to make it easier for you to adapt the questions to your needs.
Implementation Tip Sheet
EVV Implementation Tip Sheet for Self-Direction Programs: This tip sheet, developed with experience from states and other public entities administering self direction programs and from Financial Management Services (FMS) providers, helps states and others ensure electronic visit verification (EVV) systems mitigate fraud while supporting the flexibility of self-direction. Individual choice and control propel the cost savings, high quality of life, and positive health outcomes experienced in self-direction. Design your EVV solution around your program, not the other way around.
EVV Implementation Approaches: The 21st Century Cures Act mandates the use of electronic visit verification (EVV) for personal care services by January 1, 2019. As states move forward with plans for implementation, Applied Self-Direction will be closely monitoring efforts as they relate to self-directed services and supports. This resource addresses implementation approaches and suggests questions for stakeholders to consider moving forward.
EVV Implementation Models by State
EVV Implementation Models by State: One of the first decisions states will make when considering compliance with the EVV portion of the Cures Act is to identify the implementation model that will be used. A description of EVV implementation approaches is available here. Applied Self-Direction has been tracking decisions made by states based on information available to the public to date. This member-only resource lists each state and the District of Columbia, identifies verified choices of EVV model implementation, and includes links to a state's designated EVV website. We will update this resource as additional information is verified.
Member-Only Webinar: CMS Guidance on EVV: An Analysis In May 2018, Applied Self-Direction held a webinar to review and analyze the Electronic Visit Verification (EVV) Informational Bulletin and Frequently Asked Questions released by the Centers for Medicare & Medicaid Services (CMS). The webinar discussed what the guidance confirms and clarifies about the implementation of EVV Systems as required by the 21st Century Cures Act.
Member-Only Webinar: EVV Guidance from CMS: Where We Go From Here On January 26, 2018 the Center for Medicare and Medicaid Services (CMS) held a question and answer session for states related to electronic visit verification (EVV) implementation with a focus on state issues and concerns. Applied Self-Direction held a follow-up webinar on February 2, 2018 to share information from the January 26th CMS call and offer perspective on next steps for states, managed care organizations (MCOs), Medicaid providers, and other stakeholders.
Member-Only Webinar: EVV Guidance from CMS: What We Know So Far? In January 2018, Applied Self-Direction held a webinar, EVV Guidance from CMS: What We Know So Far. During the webinar, Applied Self-Direction reviewed CMS' latest electronic visit verification (EVV) guidelines.
EVV Good Faith Effort Exemption Requests – June 2018