CMS Issues Guidance on EVV Incorporating Feedback from ANCOR, But Outstanding Concerns Remain

Today, long-awaited guidance was issued to states and stakeholders from the Centers for Medicare and Medicaid Services (CMS) regarding new requirements for electronic visit verification, or EVV. ANCOR has been following this issue closely and was alerted by officials of this guidance being released.

CMS issued two documents: FAQs for the general public and an informational bulletin to states. ANCOR is thrilled that both documents take into consideration much of the input we provided to CMS on behalf of our members, including through multiple rounds of written feedback in the Fall of 2017 and through in-person meetings about provider perspectives between ANCOR’s Government Relations staff and CMS officials in 2017 and 2018.

Highlights from the FAQs document issued by CMS include the following:

• ANCOR had asked CMS for clarification of covered services. Although CMS could not provide full clarity, they were clear that 24-hour residential services, including group homes, would not be subject to EVV requirements.
• ANCOR expressed privacy concerns regarding the documenting of an individual throughout their day. We were pleased to see that CMS clarified that documenting from the start to the stop of the services from a person’s home were sufficient to meet the EVV requirements. Further, they clarified that GPS tracking would not be a requirement and mentioned other options to the confirm location of services provided. 
• ANCOR had requested clarification that the funding available for states for maintaining a vendor system would also apply to aggregator systems that would allow funding for providers using their own EVV system. CMS clarified that funding would apply to a state’s aggregator system, allowing this important provider choice to preserve funding eligibility.
• ANCOR had requested further guidance on funding of costs incurred to providers. Although CMS does not have the authority to directly fund providers through the legislation, the FAQ does encourage building any costs incurred to providers into provider rates.
• Compliance begins in 2019 and ANCOR had expressed concerns about states that have legislative sessions on a biannual basis that did not plan for an EVV system at this point. CMS shared that biannual legislative sessions will be taken into account if a state applies for delay in enforcement under the good faith exception permitted.

In addition, the following highlights from the informational bulleting are noteworthy:

• ANCOR expressed concern about a sole vendor option to CMS.  We were pleased to see the provider choice and open vendor option shared with states as they select their model of choice. Many of the benefits of the provider choice and open vendor models were highlighted by ANCOR members to CMS.
• ANCOR was pleased to see that the informational bulletin was clear on requirements that states consult with providers, including on their existing EVV systems, if any. Further, states are required to have a stakeholder process in place before moving forward on implementation.
• ANCOR had shared with CMS its concerns about training users of EVV systems and were pleased to see a focus on training in the informational bulletin.

Despite this progress, however, serious concerns remain regarding EVV implementation. These concerns are as follows:

• ANCOR remains concerned with the timeline for implementation. Compliance begins in January 2019 and most individuals receiving services and many providers are not aware of these new requirements. We believe there is too much at stake to move this implementation too quickly.
• Self-directed services were addressed in both the FAQs and the informational bulletin, but ANCOR is concerned about how the EVV model will work within this service system. There needs to be greater stakeholder input and involvement.
• The informational bulletin and the FAQs leave many of the decisions to the states, leaving providers with uncertainty about which models will be applied in which places, along with questions about whether they will incur unreimbursed costs and which exact services will be covered under the provisions. This may be a result of the broadness of the statutory language of the EVV requirement; if so, ANCOR believes the legislation should be revisited to provide greater clarity and consistency.

We look forward to keeping you up to date with the latest EVV news. In the meantime, be on the lookout for opportunities to take further action—your voice is critical in our effort to ensure EVV implementation doesn’t place undue burdens on the thousands of provider agencies that rely on Medicaid funding to serve people with intellectual and developmental disabilities.

For questions or comments, please contact Esme Grewal, Vice President for Government Relations, or Sarah Meek, Director of Legislative Affairs.