Private Duty

New guidance answers some questions on electronic visit verification requirement

New guidance for implementing electronic visit verification (EVV) as required under the 21st Century Cures Act may open the door for agencies to seek financial support for the cost of implementing such a system.

The 21st Century Cures Act requires states implement an EVV system for providers offering personal care, homemaking, respite and other non-medical services funded by Medicaid. EVV must be in place by Jan. 1, 2019 — or states face federal medical assistance percentage reductions of 0.25% starting in 2019 and up to 1% after 2023.

This change primarily impacts Medicaid for now, but will be coming later for Medicare and likely will be required for private duty agencies if they get institutional customers, like hospitals.

Serious penalties may befall agencies — not just states — that fail to implement EVV. Each state is expected to outline its own penalties for providers that fail to electronically verify visits for services covered by Medicaid.

Experts anticipate penalties could include rejected claims or suspension from the Medicaid program. A rejected claim is the most likely penalty because that is the existing penalty in states that implemented EVV before it was required, says Darby Anderson, chief development officer for Downers Grove, Ill.-based Addus and vice chairman of the Medicaid Partnership for Home-Based Care.

“There are federal penalties against the state for participation, so each state in turn is going to come up with its own penalties,” says Tim Rowan, editor of Home Care Technology Report in Colorado Springs, Colo. “I would think most states will make it the requirement that EVV needs to be in place in order to be paid at all.”

Key takeaways from new CMS guidance

On May 16, CMS released a 19-page informational bulletin and eight pages of frequently asked questions (FAQs) on the EVV requirement. Guidance around enhanced federal funding to help with the cost of EVV system implementation may offer some help for agencies as well as states, Anderson says.

In the new documents, CMS explains this funding may be available “if the state’s EVV system is operated by the state or by a contractor on behalf of the state.”

Anderson contends a contractor could be interpreted as an agency providing in-home care, which could qualify that provider for additional federal matching to fund the required EVV system.

“I think the guidance kind of throws up that option,” Anderson says.

Many states aren’t on pace to have an EVV system in place by the Jan. 1, 2019, deadline, Anderson adds. The new guidance indicates agencies in struggling states could see a delay in implementation.

In response to question No. 9 in the FAQs, CMS says if a state has made a good faith effort but has “encountered unavoidable system delays,” the penalties won’t be imposed for 2019.

Implement these EVV best practices

  • Know which model your state has selected. The available options for EVV systems may depend on the state you are in and the model your state has selected. Each state will decide whether to utilize a closed or open model.
  • Find out if your vendor is on the list. Open model states are still approving vendors one by one, Rowan says. Make sure the EVV vendors you evaluate are on the approved list so you don’t waste time.
  • Look for compatibility with existing systems. If your agency already has an electronic medical record (EMR) system in place, compatibility with that system should be among the first things to consider when selecting an EVV option, Rowan says.
    A great EVV system that would force you to purchase a new EMR system may not be the most cost-effective option.
  • Ask the right questions. If you are in an open model state, Anderson recommends asking the following questions when determining the best EVV option for your agency: Do my caregivers have and utilize smart phones? What is the scope of my agency’s service? What do I think that scope of service will be in the future? Am I a provider in one area or one state? Am I multi-state provider or do I plan to be in the future?
    If your agency’s caregivers don’t have smart phones, for instance, it may be better to look for an EVV option that does not require that kind of technology.
    Similarly, you will need to find an EVV solution that will be compliant in each state you plan to serve.
    “This technology has to work for everybody,” Anderson says. “And when I say everybody, it should work for the caregiver, it should work for the client, it should work for the end user, it should work for the state, it should work for the provider.” — Kirsten Dize (kdize@decisionhealth.com)