Overview
Even though Electronic Visit Verification (EVV) has been in use for a while, the 21st Century CURES Act mandated the use of EVV for Medicaid providers. The Cures Act initially required states to implement an EVV (Electronic Visit Verification) system by January 1, 2021, for Medicaid-funded Personal Care Services (PCS) and by January 1, 2023, for Home Health Care Services (HHCS) that require in-home visit by a provider. Many states received exemptions and deferred implementation of EVV for a year or two. As of January 1, 2023, nearly 80% of the states require EVV for Personal Care Services. Quite a few states also require EVV for Home Health Care Services (Skilled).
This blog will review EVV requirements and the steps Home Care Agencies should take to implement EVV in their agencies.
21st Century Cures Act
21st Century Cures Act supports seamless and secure access, exchange, and use of electronic health information. The rule is designed to give patients, and their healthcare providers secure access to health information.
Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020, and HHCS by January 1, 2023. Many states received exemptions and deferred implementation of EVV for a year or two. As of January 1, 2023, nearly 80% of the states require EVV for Personal Care Services.
Under the Cures Act, services starting or stopping in the patient's home are subject to EVV requirements. Capturing the location where the services started and stopped is sufficient to meet the Cures Act’s requirements.
The purpose behind EVV is to ensure that PCS and HHCS visits being billed to Medicaid are actually taking place and that the services are provided to the right patient at the correct location. Reimbursement for Medicaid visits will be linked to EVV to reduce fraud.
Electronic Visit Verification (EVV)
Electronic Visit Verification (EVV) is an electronic system that uses technology to efficiently verify home care visits by collecting location, time, and services provided at patients' homes. EVV reduces error and improves the integrity of the services by ensuring that the services are provided to the correct patient and at the right location.
Electronic Visit Verification (EVV) system must be able to electronically verify the following for visits conducted as part of the PCS or HHCS:
The type of service performed
The individual receiving the service
The date of service
The location of the service delivery
The individual providing the service
The time service begins and ends
The following are the three options to capture the location of the service.
Global Positioning Services (GPS): The GPS option uses Global Positioning Services (GPS) chips in the mobile phone to capture the exact location where the service is provided. GPS option is the most frequently used for EVV.
Interactive Voice Response (IVR): The IVR option uses Interactive Voice Response (IVR) to capture the location. IVR option requires the caregiver or employee to check in and out using a landline or cellular device at the patient's home.
Fixed Visit Verification (FVV): FVV option uses a small, fixed device stored at the patient’s home to verify the location where the services were provided. Caregivers will press a key to get a code (usually six digits) at the start and end of the visit. Codes will contain the location and time for the start and end of the shift. The FVV option may be used without connectivity and a landline to verify the location.
EVV Implementation Options for States
Under The 21st Century CURES Act, states can implement one of the two EVV models if it meets minimum mandated requirements. The following are the two models:
Open Model
Open Model is a vendor-agnostic system that can receive EVV data from any Home Care Software. The state selects the EVV aggregator and establishes the EVV configuration and data requirement. The state allows home care agencies to choose and use their software platform for EVV. EVV aggregator will be required to provide a standard interface option for third-party EVV software platforms to send EVV data to the aggregator. It is up to the home care agency and the software vendor to send EVV data to the state aggregator.
Open Model allows the agencies to choose the home care software platform that will meet their needs based on the services they provide. Using one software platform for agency operation and EVV eliminates the need for multiple systems.
Closed Model
The state selects the EVV aggregator and the EVV solution in the Closed Model. Home care agencies must use a state-selected vendor to collect and submit EVV data. EVV solution is usually free for home care agencies.
Even though the EVV software is free for Home Care, the Closed Model has many disadvantages. In the Closed Model, Home Care Agencies are forced to use multiple software solutions to manage operations and EVV. An agency may have to use various EVV systems depending on the payers and the number of states they operate.
Most states have settled on a model and selected one or more EVV vendors at this stage. Some states have allowed MCOs to establish their own EVV vendors. Even though some states chose the Closed Model, more states have chosen Open Model, providing flexibility to home care agencies.
EVV Implementation Strategy for Home Care Agencies
The Cures Act requires the implementation of an Electronic Visit Verification (EVV) system for home care agencies providing Medicaid-funded services.
The following are some key considerations for home care agencies to implement EVV.
State Guidelines and Requirements
Understanding state guidelines for EVV is critical to successfully implementing EVV. EVV Model (Closed or Open), EVV Data Submission Requirements, Claim Submission Requirements, and the services provided will determine the approach for EVV implementation. When an agency provides services in multiple states, the requirements for all states must be considered.
Services Provided
States may have different EVV submission requirements based on the services provided by the agency. The agency should check if they are providing any EVV-mandated services. If the services provided fall within EVV-mandated services, the agency can implement EVV.
Payer Requirements
Understanding the payer mix (MCOs) and their EVV requirements is critical in determining EVV implementation strategy for home care agencies. Some states have one EVV Aggregator to receive EVV data for all payers, while others might allow the MCOs to choose their own EVV Aggregators. A home care agency may have to send EVV records to more than one EVV Aggregator.
Claim Requirements
Agency must review the claim submission requirements for the state and the payers. Some payers will receive the claims directly from EVV Aggregators based on the EVV records submitted by the agency. Some other payers will require home care agencies to submit the EVV records to the EVV Aggregators and the claims to the payer.
EVV Vendor Partner
State-selected vendors usually provide EVV services to agencies for free. Even though it is tempting to use free EVV software, home care agencies should take a holistic view before settling on an EVV software platform. Cost savings of using free EVV software might not offset the additional cost associated with using multiple software platforms for agency operations.
Home Care Agencies should look for an integrated software platform supporting multiple states, payers, and services. A configurable EVV platform will allow the agencies to use one software to meet all their EVV and operational requirements.
Conclusion
Successful implementation of EVV at home care agencies will require a complete understanding of EVV requirements by states and selecting the right partner to meet those disparate and complex requirements. CareVoyant has a comprehensive and configurable Home Care EVV Software platform to meet all EVV requirements and improve operational efficiency and the bottom line of a home care agency.
ABOUT CAREVOYANT
CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.
CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.
For more information, please visit CareVoyant.com or call us at 1-888-463-6797.
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