{"id":430809,"date":"2019-03-24T12:44:31","date_gmt":"2019-03-24T19:44:31","guid":{"rendered":"https:\/\/disabilityvisibilityproject.com\/?p=430809"},"modified":"2026-02-12T17:20:38","modified_gmt":"2026-02-13T01:20:38","slug":"electronic-visit-verification-evv-is-here","status":"publish","type":"post","link":"https:\/\/disabilityvisibilityproject.com\/2019\/03\/24\/electronic-visit-verification-evv-is-here\/","title":{"rendered":"Electronic Visit Verification (EVV) Is Here"},"content":{"rendered":"

Electronic Visit Verification (EVV) Is Here: What you need to know and how to get involved<\/strong><\/h3>\n

<\/h4>\n

Kendra Scalia<\/b><\/h4>\n

 <\/p>\n

The <\/span>21<\/span>st<\/span> Century Cures Act<\/span><\/a>, signed into law December 2016, requires all home health care services and personal care services paid by Medicaid to use electronic visit verification (EVV) systems. This means that each visit made by an individual to assist a disabled consumer in their home must be tracked through an electronic method starting January 1, 2020.<\/span><\/p>\n

For many disabled people who receive assistance in their home, EVV has been a part of their daily life due to local regulation or home care agency policy. Now, all people with disabilities and older Americans who require in-home assistance will be subjected to some form of electronic monitoring.<\/span><\/p>\n

As a power wheelchair user with non-invasive ventilation needs, my daily independence relies upon a small staff of employees called personal care assistants (PCAs) coming into my home to lift me out of bed, bathe and dress me, cook my meals, clean my home, wash my laundry, drive my vehicle, and assist at night with operating my ventilator and turning my body to keep my skin healthy from pressure sores.<\/span><\/p>\n

Since 1997, I have hired my own PCAs through the consumer-directed service model. I train my staff how to help me. I manage their work schedules. I supervise the work they complete. I sign off on all timesheets. I submit timesheets to a third-party responsible for payroll processing called a fiscal intermediary (FI). And, when necessary, I have the difficult task of firing individuals. As a consumer in this model, I am the legal employer. Navigating these work relationships in a very intimate environment is difficult yet a right my community fought for and one I will never willfully give away.<\/span><\/p>\n

In contrast to the consumer-directed model is the traditional home care agency model. Private agencies hire individual caregivers. The agency is the legal employer. The disabled consumer in a traditional home care agency model is considered a patient or client. \u00a0The agency schedules when an employee works and with which patient the employee will visit that day. The patient has no choice regarding who enters their home, when they arrive or leave, the manner in which assistance is provided, or how they are trained. The patient or client is not responsible for supervising or documenting hours worked by the employee via timesheets.<\/span><\/p>\n

Medicaid is a federal healthcare program that is administered at the state level. Each state must provide a minimum level of Medicaid services as mandated by the federal government. However, states have the right to offer more services or offer the services in a different manner, such as through HCBS (home and community-based services) waivers. This is why the Medicaid program looks different state to state, but at its core provides similar assistance. Medicaid services are paid partially through federal funds and partially through state funds.<\/span><\/p>\n

States that do not implement EVV by the deadline will lose a percentage of their federal Medicaid funds. Since Medicaid is a large program, these cuts can mean millions of dollars per year lost for one state. With very little time remaining for implementation, states are scrambling to quickly select and implement a model and EVV system.<\/span><\/p>\n

There are a few different models a state may choose. Most models fall into the following categories:<\/span><\/p>\n

State Choice Model<\/b>. The state Medicaid department selects one or two approved vendors and\/or systems. There is often no cost to providers to implement the state-run system. Under this model, the Cures Act will provide states some reimbursement for the costs of EVV systems. This is called a <\/span>closed model<\/span><\/i>.<\/span><\/p>\n

Managed Care Model<\/b>. These is most common in states where Medicaid operations have been privatized without use of a third-party fiscal management agency. Managed Care Organizations (MCOs) are responsible for choosing vendors and EVV system(s) that their enrolled beneficiaries (the consumers) must use. This is also a form of a <\/span>closed model<\/span><\/i>.<\/span><\/p>\n

Provider Choice Model<\/b>. The state does not become involved with decision-making processes. Each home care agency provider or fiscal intermediary must choose a vendor and select their own EVV system(s). Home care agency providers and fiscal intermediaries must fund 100% of their own EVV systems. This is called an <\/span>open model<\/span><\/i>.<\/span><\/p>\n

Open Vendor Model<\/b>. The state selects a single vendor and EVV system(s), while simultaneously allowing home care agency providers and MCOs to continue using existing EVV systems. This is often referred to as a <\/span>hybrid open model<\/span><\/i>.<\/span><\/p>\n

It seems simple enough. The state chooses a model. The state or provider chooses an electronic visit verification system. The consumer and employee use EVV to track their visits. So, what\u2019s the big deal? <\/span><\/p>\n

Once a model is chosen by the state, the responsible agencies must enter into contracts with EVV vendors that create and sell different types of EVV systems. <\/span>These vendors<\/span><\/a> were the primary authors and lobbyists of the electronic visit verification mandate found in the Cures Act. They are uniquely positioned to make billions of dollars selling their EVV products to states.<\/span><\/p>\n

Up to now, vendors have done a decent job controlling much of the conversation related to how states must meet the Cures Act requirements. Their resounding message is that consumers and employees commit fraud on such a regular basis that only the most intrusive EVV systems will protect a state. They promote the usage of EVV systems that can include geolocation tracking, geofencing (an imaginary perimeter is placed around the home address whereby all uses of the EVV system that occur outside of the area will be denied payment), biometric data collection, cameras and even audio recording. It shouldn\u2019t be surprising that selection of these intrusive components cost more than systems without these features.<\/span><\/p>\n

Vendors have even organized together into their own <\/span>National Electronic Visit Verification Association<\/span><\/a> (NEVVA) with a stated mission to serve \u201cas the single source for Electronic Visit Verification industry-related information for states, managed care organizations and providers.\u201d<\/span><\/p>\n

Creation of NEVVA occurred partially in response to the disability community and advocate actions. In 2017, myself and an advocate from Ohio, Alicia Hopkins, formed a national grassroots campaign called <\/span>Stop EVV<\/span><\/i><\/a> with a mission to educate the public on the dangers of intrusive EVV system components. Early 2018, the National Council on Independent Living (NCIL) announced that they were creating an EVV Task Force and later released a <\/span>Statement on EVV Principles and Goals<\/span><\/a>. ADAPT activists quickly joined the fight, echoing consumer concerns and rallying at Congresswoman Diana DeGette\u2019s Colorado office.<\/span><\/p>\n

Consumers in both California and New York became vocal about the impact of EVV on consumer-directed programs. New York consumers <\/span>produced recommendations on system choice<\/span><\/a> for implementation in their state. In California, two domestic worker labor unions SEIU Local 2015 and United Domestic Workers (UDW) joined consumer voices to speak out against use of EVV.<\/span><\/p>\n

Advocates helped pass a <\/span>delay bill<\/span><\/a> last summer that moved the EVV implementation deadline from 2019 to 2020. The delay bill also strengthened language to ensure the Centers for Medicare and Medicaid Services (CMS), the federal agency charged with writing guidelines and overseeing Medicaid programs, have a more robust stakeholder engagement process.<\/span><\/p>\n

By now, most people are aware that the Cures Act requires EVV systems to capture six pieces of information: the type of service provided (home health care service or personal care service); the person receiving the service (consumer); the person providing the service (employee); the date of the service; the location where the service was provided; and the time the service begins and ends.<\/span><\/p>\n

What isn\u2019t often discussed are other requirements dictated in federal law. In addition to the information collected by EVV systems, the state is also mandated to:<\/span><\/p>\n