Electronic Visit Verification
Choosing a model and vetting vendors
Monday, July 16, 2018

Editor's Note, July 23, 2018: On July 17, 2018, Congress approved legislation delaying the start of electronic visit verification until January 1, 2020. States are able to further delay until 2021 if unable to meet the requirements. Read more, here.

Background:

In mid-May, the Centers for Medicare & Medicaid Services (CMS) issued new guidance on electronic visit verification (EVV), in accordance with section 12006(b) of the Cures Act. CMS released a bulletin of strategies and best practices, as well as an FAQ document for home health providers. Under section 12006 of the Cures Act, all states and territories must require the use of EVV for home health (HHA) and personal care services (PCS) that require an in-home visit from a provider. States are required to implement EVV for PCS by January 1, 2019, and HHAs by January 1, 2023. (Read more from NAHC here.)

Questions for Vetting Vendors

  • What has been the experience of beneficiaries and providers using the system (e.g., helpdesk responsiveness, ease of use, ability to integrate with third-party payroll and scheduling systems, common complaints)?
     
  • What is the rate of data entry errors among providers (e.g., missing/invalid check-ins, incorrect beneficiary or provider information, etc.)
     
  • Has the EVV system been shown to reliably verify type of service performed, individual receiving the service, date of the service, location of service delivery, individual providing the service, and time the service begins and ends? How are these verified?
     
  • What is the extent to which the EVV system covers the services subject to section 1903(l) What is the EVV vendor’s plan for scaling up the current system to ensure complete coverage (e.g., adapting software, developing new training materials)?
     
  • Is the EVV system interoperable with the state’s Medicaid enterprise systems?
     
  • Has the EVV system resulted in demonstrable savings to the state’s Medicaid program through reduced fraud, waste and abuse?

6 Verification Criteria

  1. Service type
     
  2. Individual receiving the service
     
  3. Date of service
     
  4. Location of service delivery
     
  5. Individual providing the service
     
  6. Begin and end times of service

Models of EVV States may choose from these models:

  • Provider Choice Model
     
  • Managed Care Plan (MCP) Choice
     
  • State Mandated
     
  • In-House System
     
  • State Mandated External Vendor
     
  • Open Choice Model

Find more information on electronic visit verification here.