Under the terms of the 21st Century Cures Act (Cures Act), providers of Medicaid-funded personal care services (PCS) and home health services (HHCS) must be fully compliant with their state’s electronic visit verification (EVV) systems by January 1, 2023.
Congress passed the Cures Act on December 13, 2016. To increase transparency and reduce fraud related to the delivery of health care services, this law required, among other things, that states establish EVV systems for all Medicaid-funded (including under waiver programs) PCS by January 1, 2019 and HHCS by January 1, 2019 January 2023, in each case if the Services involve a home visit by a Provider. Subsequent legislation extended the deadline for PCS to implement EVV requirements to January 1, 2020. However, the deadline for HHCS remains January 1, 2023 and is rapidly approaching.
Providers of PCS and HHCS services should ensure they are working towards implementing EVV systems in their own operations in accordance with applicable government requirements, most of which also require provider compliance by January 1, 2023
EVV requirements according to the spa law
EVV refers to the use of electronic systems to check the use and provision of services. To comply with the spa law, EVV systems must electronically check:
- the type of service provided,
- the person receiving the service,
- the service date,
- the place of performance,
- the person providing the service,
- and the time at which the service begins and ends.
PCS and HHCS services that are subject to EVV requirements are very broad: Any services that require a home visit and are included in the claims under the PCS or HHCS categories on the Centers for Medicare & Medicaid Services (CMS) Form-64 must meet EVV requirements even if bundled across different services or provided through a managed care provider. Medical items delivered by post or collected from a pharmacy that do not require a home visit for administration or set-up are not subject to these requirements, but if a medical item requires a home visit, the EVV requirements apply.
PCS services covered by this rule are provided at:
- the state care allowance,
- Abstaining from home and community services,
- state plan options for home and community-based services,
- Self-Directed Personal Care Companion Service Programs,
- the Community First Choice State Plan option,
- and Section 1115 demonstration projects of the Social Security Act.
HHCS includes any Services provided pursuant to Section 1905(a)(7) of the Social Security Act or a waiver.
CMS has interpreted “home visits” to exclude PCS services provided in shared apartments where 24-hour service is available.
State EVV systems do not have to be uniform
The Cures Act does not require states to use a specific or uniform EVV system, but unless a state has applied for and been granted a “good faith effort” exemption, a state that does not implement the EVV requirements will be denied medical Federal supply reduced by certain percentages. Enforcement of compliance with EVV requirements for providers occurs at the state level, and providers who do not comply with state requirements may face denied claims and other penalties.
In May 2018, CMS issued guidance outlining five key EVV system models that providers may be required to use, depending on the specific states in which they operate:
- Provider choice model (providers are allowed to select an EVV provider)
- Managed Care Plan Model (the Managed Care Plans choose an EVV provider)
- State-mandated in-house system (the state authority creates and manages its own EVV system)
- Government commissioned external provider (the government agency selects an EVV provider)
- Open-choice model (the state implements one of the state-mandated models while allowing providers and/or managed care plans to continue using existing compatible EVV systems)
Because of the flexibility that states are allowed to choose the EVV model and when to implement it, PCS and HHCS providers must confirm the specific requirements for the state or states in which they operate. States also have different views on which billing codes are subject to EVV. For example, New Jersey and Indiana have published extensive lists of applicable billing codes, but other states such as Arizona and Maine reference shorter lists. Other states have not yet published guidance on applicable billing codes.
The Therapeutic Products Act does not exempt rural areas, but states also have discretion as to which EVV system works best, including for rural areas, as long as all 6 screening criteria are covered. However, nothing in the Cures Act prevents states from requiring additional information to control fraud, waste and abuse. Some EVV options do not require a Medicaid beneficiary to provide technology, such as B. an internet connection or a GPS signal. Whilst this offers flexibility, the grab bag of EVV options has created complexity and confusion for providers, particularly those with operations in multiple states looking to comply with different EVV rules.
Some states’ compliance dates and methods vary
In accordance with the Cures Act, the vast majority of states mandate compliance with EVV requirements for HHCS providers by January 1, 2023. Some states, such as Florida (since June 21, 2021) and Colorado (since June 3, 2020), beautiful require EVV for both PCS and HHCS provider. A minority of states, including Montana, Nevada and Nebraska, are not on track to implement an EVV system for PCS or HHCS by January 1, 2023. Montana has estimated that the implementation date will be October 2023, and Nebraska and Nevada have estimated their implementation date will be January 2024.
The Executive Office of Health and Human Services (EOHHS), which administers Massachusetts Medicaid’s MassHealth program, had previously significantly delayed the implementation of its EVV program after a failed implementation attempt. However, EOHHS recently announced that it has decided to implement EVV in phases and will be reaching out to providers and relevant stakeholders in due course. For the MassHealth Personal Care Attendant (PCA) program, which is the state’s Medicaid-funded PCS program, and the Moving Forward Plan (MFP) Waiver programs, which are the state’s home and community-based service programs, EVV is funded by the PCA program implements fiscal intermediary within its time and attendance system. Agency-based providers, including those contracted with Aging Services Access Points, can either use the government-sponsored EVV program known as MyTimesheet, or purchase their own EVV system and submit data to EOHHS at least monthly.