Capitol Correspondence - 05.08.18

CMS Implementation of Electronic Visit Verification is Imposing an Unfunded Mandate on States, Taking Funds from Services for People with Disabilities

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How EVV Threatens to Affect I/DD Supports

In a series of reports, the U.S. Department of Health and Human Services’ Office of the Inspector General discovered that Medicaid-financed personal care services delivered in consumers’ own homes could be fraudulently billed due to the lack of onsite supervision. Congress responded with Section 12006 of the 21st Century Cures Act, which established the EVV requirements. These requirements apply to “personal care services or home care services requiring an in-home visit by a provider” that are provided under a Medicaid State plan or under a waiver of the plan.

In addition to being unclear regarding which services are affected by the requirements, the EVV statute stipulates both a short implementation deadline—January 1, 2019—and Federal Medical Assistance Percentage (FMAP) reductions for failure to comply. It is ANCOR’s understanding that CMS will adopt a broad interpretation of which service providers are required to comply, meaning the majority of the services that ANCOR members provide will be impacted and state Medicaid authorities will be left grappling with an unfunded mandate.

There are three particular challenges with the ways in which EVV is currently moving toward implementation:

CMS Implementation Is Moving Forward Without Adequate Input. 

  • Departing from established past administrative practice, CMS is not issuing a federal regulation to guide implementation of the new EVV requirement, which would permit public comment.
  • Currently, states are attempting to implement EVV programs based on two CMS PowerPoint presentations a couple of unrecorded conference calls with individual state Medicaid agencies.

EVV Was Not Intended To Be Applied to the Majority of Services Covering People With I/DD

  • About 655,000 people with I/DD receive community-based rehabilitation services through the Medicaid Home and Community Based Services (HCBS) waiver program. 
  • It is clear that Congressional intent WAS NOT to apply the EVV requirement to people with I/DD settings like group homes—where EVV makes no policy or fiscal sense.

State Interpretation Is All Over The Map

  • Due to of CMS’ lack of clarity on the implementation, state interpretation is woefully inconsistent, with some states already applying the requirement to I/DD populations and others exempting the population.
  • The National Association of State Directors of Developmental Disabilities Services (NASDDS) and National Association of States United on Aging and Disability (NASUAD) have both written to CMS expressing deep concern.

ANCOR has been leading advocacy efforts to ensure community-based supports and services do not face the unintended consequences of the new EVV law. Thank you for joining our efforts by emailing your Senators and Representative today!