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The state of Ohio is one of the early adopters of a new electronic visit verification mandate for tracking the visitation history of home health providers who provide services for people with disabilities and other health-related conditions. Many of these services are vital for allowing individuals with disabilities to live and work in their surrounding communities.

These services are largely paid by funding from the Medicaid Waiver Program, which in recent years has been attempting to reduce fraud. Enter the state’s introduction of a new electronic visit verification system. This new system will monitor the services that individuals with disabilities receive from healthcare workers. However, this rollout has not been smooth, with people complaining about technical malfunctions, inadequate training and privacy concerns.

So what actual is Electronic Visit Verification?

Electronic Visit Verification or EVV was first introduced in the industries of home care, home healthcare and Hospice back in the 1990s. Electronic visit verification (EVV) is a telephone and computer-based system that electronically verifies service visits occur. 

EVV is an electronic tool used to monitor personal care assistants (PCAs) and home health-care workers. The main purpose of EVV was to reduce fraud and ensure that people were receiving their documented care from assigned nurses and other support staff. EVV attempts to do this by electronically verify that services billed for home healthcare, are for actual visits made by the healthcare provider. EVV systems, as a principle, were expanded due to the passing of the Affordable Care Act (ACA) in 2010.

The ACA made provisions for the reduction of fraud and over-payments by Medicaid, requiring states to stop Medicaid payments to providers when there is credible evidence of fraud. The federal 21st Century Cures Act , passed in December 2016, requires that all 50 U.S. states implement an EVV system for Medicaid-funded personal care services by January 2019 and home health care services by January 2023.

These new requirements for Medicaid-funded home health and personal care services, mandates that states implement electronic visit verification (EVV) systems to more closely monitor in-home service delivery. Many states already use EVV systems or are considering them in order to curb improper payments in this growing sector of health care.

States that fail to comply (by 2019 for personal care; 2023 for home health) will face incremental reductions in their federal match. The Federal government was vague on details so there is no prescribed solution, so states can select and implement an EVV of their own design. However, these EVV systems must include a feature that can verify the following:

[1] The Individuals who are providing and receiving the service.

[2] Date and type of the service performed.

[3] The location for the delivery of these services.

[4] Time the service begins and ends.

With this in mind, Ohio launched an EVV system on January 8th of this year in order to comply with Federal law. The state has awarded a seven-year, $66.5 million contract to New York-based Sandata Technologies in order to administer the EVV system.

The state is first issuing visit-verification devices to approximately 22,000 Ohioans covered under the home-care waiver and Medicaid state plan. At a later date, the use of EVV devices will expand to include individuals with managed-care plans and other waivers, including people served by the Ohio Department of Developmental Disabilities (DODD).

Ohio is one of the earliest states to actually introduce an EVV system for Medicaid services. Some states are hoping to receive further EVV guidance from the Centers for Medicare & Medicaid Services (CMS), which they will use in deciding whether to create an open model like Ohio or a closed model.

In the closed model EVV system, healthcare providers would be forced to use a single type of EVV platform. Ohio may become the test case for the rollout of this system. However, as an early adopter, the state will have more time to create a system improves productivity and the quality of care for individuals. It is beneficial for Medicaid to find ways to prevent fraud, but there is a concern that the EVV system will be excessively burdensome.

Many states, including Ohio, suffer from a shortage of health care providers. Advocates fear that adding additional reporting requirements and potential penalties on this low-wage workforce will only turn more people away from the field. Ohio is not withholding pay from health care workers who submit EVV data with errors and improperly logged shifts, but this could change by July.

The platform that Ohio’s Electronic Visit Verification system uses cellphone technology with GPS monitoring. The state is using an “open model” for EVV, which means that home care providers can choose to use the platform offered by the state, at no charge, or they can pay out of pocket to work with EVV vendors that have been certified to meet the Cures Act requirements. 

This change is not universally well-received, with many people concerned over privacy violations and a feeling from recipients and health workers that they are being tracked. Due to this concern, some individuals have opted for the alternative EVV method which is a call-in model that requires voice verification.

“Basically, every time you log in or log out, it records the location,” according to one user of the new EVV system. “Now, if you’re in your home or within 1,000 feet (of your home), you don’t have to do anything extra. But if it’s an unknown location that’s not associated with the consumer, it’ll show up as an exception.”

The Ohio Department of Medicaid is actively addressing Medicaid Waiver providers and recipient’s concerns. It is estimated that about 90,000 Ohioans will have to use some form of GPS device in order to meet the EVV system federal requirement.

Many other states are taking a wait and see approach. For example, California, the largest state by population, is waiting to implement their EVV system. California plans to introduce their Electronic Visit Verification system at a later date. Officials in California are currently analyzing the impact of EVV on personal care services, but not on home health services.

The 2023 implementation data has provided the state with plenty of time to access home health services at some future date. Ideally, the goal of an Electronic Visit Verification system is to make health care workers’ everyday activities simpler and more efficient.

As previously mentioned, every state in the country must have some type of electronic visit-verification system in place by these dates or face a reduction in Medicaid funding. However, as EVV is introduced across the United States, there will likely be other stories of confusion, distrust and technical glitches.

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