Introduction
Electronic visit verification (EVV) is required for Medicaid personal care services (PCS) as of January 1, 2020, though the vast majority of states received a good faith extension until January 1, 2021. 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 page 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.
Avoiding the Wrong EVV Approach: "Perfect" EVV Records
Avoiding the Wrong EVV Approach: The wrong EVV approach in self-direction could incite Fair Labor Standards Act (FLSA) violations resulting in penalties for payers, FMS entities, and/or participants, and risk creating joint employment. This alert describes the EVV approach that creates this risk, outlines the risk of FLSA violations and joint employment, and describes alternate approaches for both FMS entities and payers, including states and managed care organizations (MCOs).
EVV: A Blueprint for Self-Direction
EVV: A Blueprint for Self-Direction: this resource is intended to be useful to stakeholders developing their own EVV products, as well as to help stakeholders evaluate existing EVV products to determine whether these options will be compatible with the unique operational needs of self-direction. Like a blueprint, this resource is not necessarily comprehensive. Rather, it outlines the functionality required to support self-direction, including flexible scheduling, protocols for EVV system use in areas without internet access, and workflows that support participant control of workers’ hours.
EVV Websites by State
EVV Websites by State: CMS suggested that states “establish a website to disseminate training and other information related to the EVV program” as a promising practice in electronic visit verification (EVV) training and education. This resource provides links to state websites that are specific to EVV. Most of these websites contain links to additional information and resources specific to that state.
Implementation Approaches
EVV Implementation Approaches: This resource provides an overview of the various EVV implementation approaches that states may adopt.
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 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.
Questions to Ask EVV Vendors
Questions to Ask EVV Vendors: This 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.
Vendor Directory
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.
Personal Care Services
This resource provides a definition of personal care services, as well as other key concepts related to EVV implementation.
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 EVV for personal care services and home health services under Medicaid.
States who have not implemented EVV for Medicaid personal care services 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 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.