A recent white paper released by the National Association of States United for Aging and Disabilities (NASUAD) reported EVV technology continues to evolve and improve but challenges remain in the face of “go-live” deadlines in 2019 and 2023 mandated by Congress in the 21st Century Cures Act.

The findings were presented at the 2018 EVV Summit by Damon Terzaghi, Senior Director of Medicaid Policy & Planning for NASUAD, and Health Management Associates Principal Jennifer Burnett in the program titled, Electronic Visit Verification: Implications for States, Providers and Medicaid Participants.

New federal requirements for EVV go into effect January 1, 2019, that require the use of EVV for Medicaid-funded personal care services. EVV technology has been available for more than twenty years, but was optional for states, providers and managed care organizations (MCOs) prior to the passage of the Cures Act. In addition to mandating state Medicaid programs implement EVV for Medicaid-funded personal care services by January 2019, it also requires states launch EVV for Medicaid-funded home health care services by January 2023.

The Start of an eVVolution

Home and community-based services are delivered and verified by EVV technology to individuals needing those services. EVV technology, originally patented in 1996, continues to evolve and improve, with multiple vendors available to states, MCOs and providers, according to the NASUAD.

“EVV is a technology solution that verifies how service is delivered,” explained Terzaghi, adding that through electronic check-in, a direct care worker, aid or attendant confirms that they arrived or departed. “This could occur in a residence or an alternate location.”

“It [EVV] continues to evolve so who knows what the future will bring,” said Burnett, adding states have leeway to interpret the rules, and those not ready to implement can delay for a year if they show a good faith effort to meet the date.

The Centers for Medicare and Medicaid Services (CMS) has five design models for EVV: Provider Choice, Managed Care Organization Choice, State-procured Vendor, State-developed Solution and Open Vendor.

“We added one more CMS didn’t identify — the Provider Audit Model,” said Terzaghi.

The Provider Audit Model, proposed by at least one state, directs providers to establish a process to ensure that services are electronically verified and capture all Cures Act-mandated information.

The Path to Smooth EVV Rollout

The NASUAD report also recommends state Medicaid and agency staff set goals and define requirements for EVV, and that states engage stakeholders for input, address the unique concerns of participants with disabilities, consider existing vendor capacity and relationships, develop implementation and training plans, conduct readiness reviews, set a soft launch strategy, establish reporting requirements, and develop a framework for monitoring that will contribute to the success of the program. There should also be an openness to new and updated technology.

CMS, in partnership with states, is responsible for the administration of the Medicaid program and is charged with implementing the Medicaid EVV program.

EVV is in the Cures Act to strengthen insufficient controls for fraud, and to deter and reduce fraud, waste and abuse, according to the NASUAD report.

“It will give them a tool for strengthening that process, and to increase financial accountability,” said Burnett adding additional benefits include demonstrating what is actually happening in a person’s home, recognizing the growth of home and community-based services and improving quality and beneficiary safety.

“Increasing their safety if a visit doesn’t happen could be critical.”

Eyes on the Future

Challenges looking forward include collecting data currently lacking, quality and program integrity and alleviating privacy fears.

“Still, people are afraid big brother is watching me, tracking my worker,” said Burnett, adding that concerns are mainly among younger, disabled patients.

NASUAD represents the nation’s 56 state and territorial agencies on aging and disabilities and supports visionary state leadership, the advancement of state systems innovation and the articulation of national policies that support home and community-based services for older adults and individuals with disabilities.