Legal Expert Weighs in on EVV Progress

The 21st Century Cures Act became law in December of 2016. Within the act were future Electronic Visit Verification (EVV) requirements for home-based care providers.

But over four years later, confusion remains.

Specifically, the Cures Act mandated that states implement EVV for at-home visits conducted by all Medicaid personal care services providers and home health agencies, though each group had different go-live dates. Personal care services that were Medicaid-funded needed to abide by EVV statutes by Jan. 1 of last year; home health care agencies will need to by Jan. 1 of 2023.


Each group has had to deal with a series of delays and potential exemptions.

“In addition to verifying the time and duration of services, the intent behind the system in the statute is to ensure accurate claims disbursement and that beneficiaries of the services are getting the care they expected to be getting,” Whitney Phelps, a shareholder at the law firm Greenberg Traurig, said on a Tuesday webinar. “And also that the care was provided accurately, timely and to ensure all of those services are billed properly.”

The webinar was hoisted by the Forest Hills, New York-based Medflyt, a HIPAA-compliant web-based workforce management platform for home care agencies. The company works with more than 100 providers and 100,000 caregivers across the U.S.


The EVV process can be difficult to implement for states. But those that haven’t — or don’t — will be subject to incremental 1% deductions in federal assistance.

That’s unless a state experiences “unavoidable delays.” New York, among some other states, had its EVV mandate for personal care services delayed until Jan. 1 of this year, for example.

States were tasked with consulting with personal care services providers and home health agencies to create an EVV system that was both minimally burdensome and up to existing best practices.

The EVV process usually includes caregiver shift reminders, clock-in reminders, a caregiver clock-in via an app or a patient’s landline, automated calling reminders, real-time data collection from caregiver notes, a caregiver clock-out and then an EVV submission to a state aggregator.

The only steps that are usually mandatory, however, are the actual clock-in, the clock-out and a submission to the state aggregator.

But every state and its implementation plans are different. For instance, some home health operators will have to begin abiding by EVV requirements before 2023. But the way in which they engage with the new practice will differ.

There are five routes that states can take. They can allow a provider to choose any software they want for EVV; they can recommend a solution but allow providers to still choose; the state can provide a solution — mostly for free — but still allow freedom of choice; they can hire Managed Care Organizations (MCOs) to decide how providers need to submit EVV data; they can also completely mandate that providers use certain solutions for EVV.

The Centers for Medicare & Medicaid Services (CMS) has allowed states to choose which route they want to go, taking the path that best fits their needs.

Whatever EVV solution a provider chooses, it must still abide by the state’s EVV requirements, even if freedom of choice exists. In some instances, providers can choose two different systems to work with — one strictly for billing and one for EVV.

Application Programming Interfaces (APIs) have also been developed so that two applications or systems can communicate with each other.

Still, problems can arise for providers operating in multiple states. Free systems offerings are likely to be straightforward, but if they differ in two areas that a provider serves, it will create extra legwork for them.

“I think one of the biggest points or purposes behind all of the EVV is to really try and create a system that is ensuring that the proper care is being delivered at the right time, in the right setting and to prevent any forms of fraud, waste and abuse,” Phelps said.

The home care industry has been tied to bad actors in the past, which is at least part of the reason why EVV has been implemented on a state-by-state basis across the country.

“Now, you’re kind of having to show good acting,” Phelps said. “So some of this is a result of that, but I do think it is about trying to get a better sense of our home care services that are being provided to ensure that Medicaid dollars in particular are being used effectively and efficiently.”

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