In-home care providers, state Medicaid programs and their tech-vendor partners will very likely have at least one more year to gear up for the federally mandated nationwide rollout of electronic visit verification (EVV).
That is, depending on what President Donald Trump decides to do.
The U.S. House of Representatives last month signed off on H.R. 6042, a widely supported piece of bipartisan legislation that delays EVV implementation until 2020 and pushes back potential penalties that personal care providers may have otherwise incurred. H.R. 6042 is more commonly known as the Guthrie Act, in reference to its main sponsor, Rep. Brett Guthrie (R-Kentucky).
Following the House’s lead, the Senate unanimously approved the legislation last week. The Guthrie Act now sits on the president’s desk for him to sign or veto. Alternatively, the president can do nothing, in which case the bill would become law after 10 days.
H.R. 6042 was formally sent to Trump on July 19.
“Most of us in the industry expect the president to sign the legislation,” Sandata Technologies CEO Tom Underwood told Home Health Care News in an email. “It has strong bipartisan support.”
Sandata Technologies is a provider of workforce and operational management solutions that enable government agencies, managed care organizations and home care providers to streamline services. The New York-based company has helped implement EVV solutions in Connecticut, Illinois, Ohio, Tennessee, Rhode Island and at least eight other states.
The nationwide rollout of EVV was mandated under the 21st Century Cures Act.
“Numerous states have either implemented an EVV solution that is [Cures Act] compliant or are in the process of procuring and implementing a solution that meets the requirements of the EVV mandate,” Underwood said. “However, there are a number of states that have struggled to make substantial progress toward meeting the deadline and requirements of the Cures Act, and, for those states, we believe a delay is appropriate and reasonable.”
Some industry voices, though, say that an EVV delay may not have much practical effect, given preexisting leeway in implementation deadlines and the need for providers to keep pushing toward having compliant EVV solutions in place sooner rather than later.
The original plan and the Guthrie Act
The $6.3 billion 21st Century Cures Act calls for EVV implementation by Medicaid-reimbursed home care providers and state agencies by Jan. 1, 2019.
The general idea behind the mandate is that EVV will help curb fraud and abuse by having caregivers verify when, where and how services were provided to patients through the use of mobile applications and other tech-based methods.
Specifically, EVV systems must be able to verify the type, date, location and duration of a home care service provided, according to policy. Systems must be able to verify who exactly gave and received services as well.
In adopting EVV policies, states are able to choose between “open” or “closed” models. State-sponsored open models allow providers to choose from a variety of certified EVV systems and vendors, while closed models require agencies to use a single approved EVV option.
Nearly three dozen states have finished or taken significant steps toward putting verification systems in place, according to the Partnership for Medicaid Home-Based Care (PMHC).
States that don’t comply with EVV requirements face federal funding reductions, though good faith waivers are available for those that experience technical delays or unforeseen challenges.
If signed into law, the Guthrie Act would delay EVV implementation to Jan. 1, 2020. Additionally, penalties would be off the table for 2019. Likewise, the Centers for Medicare & Medicaid Services (CMS) would be able to waive penalties in 2020 when appropriate.
“PMHC recognizes that some states have incurred legitimate implementation hurdles in getting all personal care populations and programs they administer compliant with the federal EVV mandate, including securing budget appropriations or other authority required under state law,” Darby Anderson, vice chairman of the organization’s board of directors and chief development officer for Addus Home Care, Inc. (Nasdaq: ADUS), told HHCN in an email. “Therefore, we understand the action of Congress to grant more time for states to become fully compliant.”
“It is more important for EVV systems be implemented properly than for them to be implemented quickly,” he added.
PMHC supports the use of EVV, Anderson said.
Home health agencies have until 2023 to implement EVV solutions throughout their operations under the 21st Century Cures Act. That still appears to be the case even if H.R. 6042 becomes law.
Besides delaying EVV, the Guthrie Act also requires CMS to convene at least one public meeting in 2018 for feedback from Medicaid stakeholders.
“The original bill had a good faith effort provision so that the FMAP reductions wouldn’t be implemented if the states were working toward an EVV solution,” CellTrak CEO Mark Battaglia told HHCN. “From our perspective, this bill is buying time that might have been bought already.”
Chicago-based CellTrak offers care delivery management tools that include EVV. It has customers—including Addus—in the United States, the United Kingdom and Canada.
“I don’t think anybody is going to go, ‘Ok. I can take my foot off the gas for a year,’” Battaglia said. “This is just going to continue the trend that’s happening—the law will change, but I don’t think it changes much for the industry.”
Addus CEO weighs in
Despite more leeway, Frisco, Texas-based Addus will continue its EVV efforts, Dirk Allison, the provider’s president and CEO, told HHCN via email.
The delay won’t affect Addus, but it may be beneficial for smaller providers that need the extra wiggle room, he said.
“This delay doesn’t particularly affect Addus, which has been implementing EVV and will meet the original date—the start of 2019—to be compliant,” Allison said. “The delay could be beneficial for smaller regional and local providers, though many will still find reaching compliance a challenge because of the initial and ongoing investment required.”
On a high level, EVV has both positives and negatives, according Allison. But while EVV can help improve quality care and ensure delivery, it can also be restrictive and burdensome on an administrative level.
“This technology is a step forward in improving the cost advantages of in-home care, which benefits consumers, as well as government and managed care [payers],” he said. “It is also another example of the increasing cost and complexity required to compete effectively in the home care business, which is increasing industry consolidation pressures.”
Written by Robert Holly