Going Hybrid? Charge Your EVV

By Monica E. Oss

If your organization is one of many that is thinking about moving to a hybrid service delivery model—virtual, in-clinic and in-home—your team will need to learn more about electronic visit verification (EVV). EVV was mandated for all home-based services by the 21st Century Cures Act, passed in 2016. The act required all state Medicaid programs to start using EVV for personal care services (PCS) by January 1, 2020 and for home health care services (HHCS) by January 1, 2023. EVV is essentially electronic verification that in-home service encounters actually occur and documents the type of service performed, the individuals providing and receiving the service, the date and location of the service, and the time the service begins and ends.

For PCS, many states applied to the Centers for Medicare and Medicaid (CMS) for “good faith exemptions” and received an extension until January 1, 2021. States are in different stages of implementation and some already require EVV for HHCS as well (see What Are The EVV Compliance Rules In Your State?) States that don’t implement EVV will have to take a cut in their annual federal medical assistance percentage (FMAP) starting at 0.25 percentage points and gradually increasing to one percentage point (see States Must Use Electronic Visit Verification By January 1, 2020 For Medicaid Personal Care Services).

EVV is required for all Medicaid covered in-home visits for personal care and health care services including nursing; home health aide services; and medical supplies, equipment, and appliances that are delivered via an in-home visit under the state’s home health benefit. States also may choose to require EVV for in-home physical therapy, occupational therapy, speech pathology, audiology, and other services (see Frequently Asked Questions: Section 12006 Of The 21st Century Cures Act). CMS does not require EVV in some instances—when the caregiver and consumer live together, for congregate facilities offering 24-hour services, or for Programs of All-inclusive Care for the Elderly (PACE)—although individual states may mandate otherwise.

While EVV does not specifically track consumers and staff, it does require multiple check-ins by staff at specified times with location identification—through a smartphone app with GPS tracking, the use of a landline phone in the consumer’s home, or signing into a device in the consumer’s home. For provider organizations required to comply with EVV mandates, the level of investment depends on the model chosen by their state. States have five options—an open model where provider organizations use their own EVV systems; EVV systems mandated by health plans; a single statewide vendor to be used by all provider organizations; build and manage a state-owned EVV system; or allow provider organizations to opt to use the state system or their own EVV system compatible with the state’s data aggregator (see EVV Systems Section 1: Requirements, Implementation, Considerations, & State Survey Results).

While the intent of EVV is to avoid fraud and ensure that consumers get the services they are supposed to get, there is widespread concern by consumers and advocacy groups on the practical challenges and alleged threats. For example, caregivers in Arkansas have complained about glitches in the state-mandated EVV app that have resulted in missed service entries and delayed paychecks. The Arkansas compliance requirements also have been criticized for placing undue burden on on live-in caregivers and on self-directed consumers who hire their caregivers directly and manage their own services. And some stakeholders do not like the sense of “constant surveillance.” Consumers complained that having an EVV system was comparable to having a wireless dog fence or ankle monitor (see ‘We Don’t Deserve This’: New App Places US Caregivers Under Digital Surveillance).

Other concerns have been expressed about the EVV impact on consumers—the Arc describes it as a “civil rights issue because of the concern around unintended consequences of impeding upon an individual’s privacy rights.” EVV systems that have video and audio recording functionalities and geotracking are not acceptable (see Call For Electronic Visit Verification Delay Grows Strong Nationwide). The National Council on Independent Living decried EVV for being “based on the archaic and offensive idea that disabled people and seniors are unable to leave their homes.” They criticized EVV for requiring multiple check-ins a day from the same location, for geotracking, and for imposing additional burdens on states (see NCIL Position Opposing Electronic Visit Verification).

What are the implications of EVV for specialty health and human service provider organizations offering home-based services? There are a few big issues to contend with—adopting new technology, creating new service delivery workflows, revising policies and procedures, training staff, and educating consumers and obtaining their input. OPEN MINDS Senior Associate Jason Lippman said, “EVV plays into a lot of digital trends we are seeing all around us—requirements for more data and more accountability. And the systems that work as intended can provide more data for planning and management of resources. The key is designing systems to collect that data that are least intrusive for both consumers and staff, creating efficiencies, and mitigating for unintended consequences and privacy issues.”

Like the EHR requirements of the past decades, the requirements for documentation of services delivered in home-based settings are likely not going to go away. And, it is likely that the EVV requirements will prove to be another factor—like value-based care, interoperability requirements, and hybrid service delivery models and ecosystems—that put larger organizations with better technology planning competencies at an advantage. Mr. Lippman pointed out, “As we gear up for 2023 and wait for the HHCS provisions around EVV to kick in, provider organizations should not put off being prepared—now is the time to start looking into what the state is currently doing with PCS, and to initiate the infrastructural and operational changes that will be required to accommodate digital tracking of remote services.”

For more on EVV preparation and management, check out these resources in The OPEN MINDS Circle Library: