The Use of National Provider Identifiers for Self-Directed Workers

The 21st Century Cures Act requires states to operate electronic visit verification (EVV) systems for personal care services offered via Medicaid. These EVV systems must verify six key data elements, including ‘the individual providing the service.’ States have adopted various approaches to capture this data element, including by requiring self-directed workers to obtain a National Provider Identifier (NPIs) or an alternative identifier.

This policy brief provides background on the use of NPIs and other numeric identifiers in self-direction and identifies key considerations, challenges, and alternatives for states. Requiring NPIs for self-directed workers presents multiple challenges whereas a well-executed system for assigning alternative identifiers may be a better option for self-direction.