Electronic Visit Verification (EVV)

What is Electronic Visit Verification (EVV)? Electronic Visit Verification (EVV) is a technology solution that validates services billed for home and community-based personal care or home health services for actual visits made, providing accountability and safeguarding that beneficiaries who are authorized to receive services get the expected care. In addition to combatting fraud, waste, and abuse in home healthcare, EVV is used to: • Verify visits on a real-time basis, including date, location, type of service, individual(s) providing and receiving services, and duration of service(s). • Validate hours of work for home health employees. • Eliminate billing data entry mistakes. • Reduce costs related to paper billing and payroll.   Why is Wyoming implementing EVV? In 2016, the 21st Century Cures act was passed by congress. This Act requires that states implement EVV systems to verify services submitted for Medicaid reimbursement. Which providers will be impacted? The act specifically requires EVV for all Personal Care Services (PCS) requiring an in-home visit that are provided under the Medicaid State Plan or under a waiver program. Also included are Home Health Care Services (HHCS) requiring an in-home visit provided under the State Plan or under a waiver of the State Plan. The Centers for Medicare and Medicaid (CMS) have further clarified that an “in-home” visit does not include visits to congregate residential settings where 24-hour service is available. Additionally, CMS has interpreted Program of All-Inclusive Care for the Elderly (PACE) services are not included in this requirement.   What is the deadline for implementation? CMS has set the implementation deadline for PCS as January 1, 2019. HHCS must be implemented by January 1, 2023.   What happens if Wyoming doesn’t implement EVV? Wyoming will be subject to financial penalty in the form of a decrease in the Federal Medical Assistance Percentage (FMAP) rate if EVV is not implemented by the above deadlines.

How does EVV work?

At a very high level, EVV collects location, time, and service information. There are multiple models and technologies available to providers and the State, all of which are currently being investigated and considered by Wyoming. Some examples of the technologies available include smart phone applications and Interactive Voice Response systems accessed over a client’s landline. The 21st Century Cures act does not mandate any specific model or technology be adopted by states so long as the required information is collected.

  What information is collected by EVV systems? EVV systems are required to collect six specific pieces of information to verify a visit. They are: 1. The type of service performed 2. The individual receiving the service 3. The date of the service 4. The location of service delivery 5. The individual providing the service 6. The time the service begins and ends.   What happens if there isn’t a cellular data connection where I’m providing services? Many of the EVV technologies available take into consideration off-line capabilities. Some states that have already implemented EVV systems offer a backup-verification method such as IVR through a landline. Other states use devices that are able to capture location data through GPS and store that information until a data connection becomes available for upload. Wyoming has not selected a model or specific technology to implement at this time, but this will be a key consideration when considering options.   How will the Wyoming EVV System be funded? Federal reimbursement funding is available if Wyoming implements a system that meets the associated requirements.  Alternatively, some states have chosen to use multiple system models, where providers can choose to utilize the State-sponsored system or purchase their own EVV system and provide the data to the State via batch files or similar data submission types.  As long as the information provided meets the requirements outlined by CMS in the Cures Act, there are several options for how it can be gathered.”

This presentation was shared with affected State programs in June 2018, and provides a high-level outline of EVV.  The presentation recording gives additional details and includes a question and answer session. To view the recording, please visit HERE.