EVV is here to stay.

Since the passage of the 21st Century Cures Act in 2016, Electronic Visit Verification, or EVV, has rewritten the parameters by which providers of Medicaid personal care services (PCS) and home health services log their visits.

Technically, the Cures Act mandates that all Medicaid-funded PCS use EVV as of Jan. 1, 2020.

But as providers get technology solutions in place for their compliance efforts, they should know that, in reality, they have a bit more time for implementation. That’s because leaders in every state except Tennessee have applied for a good faith exemption from the Centers for Medicare & Medicaid Services (CMS) to push the EVV deadline in their particular state to Jan. 1, 2021. As of this publication, the only state that has applied and not yet been approved is South Carolina, which is pending, as is Guam. 

But as CellTrak EVV expert Courtney Martin notes, most states operate open models, giving providers a lot of flexibility — and the need for a strong technology partner — as they get started.

“Approximately 85% of states are implementing an open model, and many of the closed models were in place before Cures,” Martin says. “Implementation is moving quickly, and providers have a lot of good information they can use to get started now.”

While EVV provides many benefits to providers and ultimately to care recipients as well, it is not without its technical challenges. Now, in a series of articles here at Home Health Care News, CellTrak EVV expert Courtney Martin will take readers through the ins and outs of all things EVV.

First up: an overview of EVV, and a look at where we are now.

Federal guidance

To become EVV compliant, providers of personal care or home health services must follow the laws within their specific states. In addition, understanding federal EVV regulations will give providers helpful perspective on requirements that all states must follow. The role of the federal government in EVV is to deliver high-level guidelines and to monitor state adoption for the purpose of adjusting the federal Federal Medical Assistance Percentages (FMAP) in the event of non-compliance.

Most recently, CMS offered guidance dictating what types of in-home caregivers must follow EVV and who is exempt, Martin said.

CMS specifies that the self-directed model — individuals who directly choose and hire a caregiver for themselves or a loved one— falls under the EVV mandate. Live-in caregivers — such as family members who provide care and reside in the same household as the recipient — are exempt from EVV, unless their state requires it.

“This is from a federal perspective,” Martin says. “States can require more.”

The other crucial guidance that CMS issued recently is the question of how states will monitor the EVV implementation of agencies in the state. One option is to use a “declining error rate,” which is a series of verification percentages that increase over time.

“If 100% of my visits are verified, then great, but that’s not realistic on Day 1,” Martin says. “There is always a ramp-up period for exiting caregivers as well as new caregivers starting, and overall a period where people are getting used to the process.”

Some states, therefore, can put a “tolerance” in place: a mandate that matches a timeline to a steadily increasing rate of verification. For example, 60% of visits would be verified after three months, 75% after five months, 95% after eight months and so on. Another option states have is to deny specific claims where EVV information is missing or incorrect.

State roles

The first major state responsibility is also the one that most directly impacts providers: determining the EVV implementation model. There are two common models, Martin says. One, used less frequently, is a closed model, where the state buys a solution and forces the providers to use one solution.

The other model is the open model, where providers can choose their own technology solution, though still within a set of state-mandated guidelines. In open model states, there is often a free option procured by the state, with flexibility given to choose any solution that meets state requirements.

“Think of a closed model as a one-size-fits-all state system,” she says. “We advocate for open EVV, which allows providers the flexibility to choose the technology which best supports their operation.”

Second, states are responsible for identifying the affected services so that providers know if they are subject to the mandate. Even though CMS is not requiring EVV for home health care until 2023, for instance, states can require it now.

Finally, states must meet the federal EVV mandate while also setting their own verification requirements, which might be more stringent than what CMS dictates. As part of this process, states will monitor provider verification efforts and enforce the state implementation requirements.

Therefore, states determine four aspects of EVV:

— The model for EVV
— The services that must be verified by EVV
— The compliance requirements
— The implementation timeline

To learn more about how CellTrak can help you navigate EVV in 2020 and beyond, visit CellTrak’s EVV state map to understand what is happening in your state — and stay tuned for more on EVV at HHCN from CellTrak.