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Electronic Visit Verification (EVV)

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Electronic Visit Verification (EVV)

In December 2016, Congress passed the “21st Century Cures Act”, a sweeping legislative package that includes new funding and resources to address a wide variety of medical topics, including the opioid epidemic, the FDA drug approval process, medical research, and behavioral health issues. Importantly for providers, it also includes new requirements for electronic visit verification (EVV) and a penalty for non-compliance starting in 2019. EVV is a system that requires providers to confirm that services were actually delivered and to do so through a possible variety of electronic methods for each service like a phone call, electronic signature, and so forth.

What is Electronic Visit Verification?

To ensure accuracy and prevent fraud, EVV systems verify, through GPS or caller-ID services: 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, and 6) the time the service begins and ends.

What the law requires
Imposes penalty in the form of FMAP reduction for states that do not implement EVV by certain dates:

  • Personal Care Services:  .25% in 2019 increasing to 1% after 2023
  • Home Health Services:   .25% in 2023 increasing to 1% after 2027

States must engage with stakeholders, including beneficiaries, family caregivers, and individuals who furnish personal care services or home health services, while designing their EVV system. For states that have already implemented (or are in the process of implementing) EVV systems, there will be no FMAP penalty so long as state demonstrates “good faith effort” to comply, or has encountered “unavoidable system delays”. 

What should providers do to prepare?

Every state will implement EVV independently and on varying time tables. Some states have already begun to implement, others have not. Providers should find out now where their state is in its process of EVV planning and implementation to ensure that they can provide input and guide the process early on. Providers should look to the agency within their state that oversees HCBS waivers, state plans, and other Medicaid services to determine where the state is in the process.  

ANCOR held a two-part webinar series to help providers understand and navigate the new EVV requirements, featuring an overview of the law and providers sharing their states' experiences implementing EVV and best practices. If you missed it, you can still purchase the recordings here.