CMS Guidance Addresses Significant EVV Questions

Topics: Federal News, HCBS, Medicaid, Program Integrity,

The Centers for Medicare and Medicaid Services (CMS) has issued an Informational Bulletin clarifying the applicability of electronic visit verification (EVV) requirements to beneficiaries with live-in caregivers, services rendered partially in the home, and to the provision of medical supplies, equipment and appliances as part of the Medicaid home health benefit. The guidance also addresses the use of web-based electronic timesheets as a method of EVV.

In the guidance, CMS makes explicit that “EVV requirements do not apply when the caregiver providing the service and the beneficiary live together.” Personal Care Services (PCS) or Home Health Care Services (HHCS) “rendered by an individual living in the residence does not constitute an ‘in-home visit’.” However, states “may choose to implement EVV in these instances, particularly when using discrete units of reimbursement, such as on an hourly basis.”

CMS also addresses the question of PCS or HHCS visits that take place partially in the home and partially elsewhere. According to the Bulletin, “EVV is only required for the portion of the service rendered in the home; however, states may choose to require more information to control fraud, waste, and abuse.” CMS suggests several EVV methods states can use for capturing services rendered partially in the home, including two suggestions for “alleviating privacy concerns regarding tracking of community locations while ensuring that the location of any portion of a service delivered in the home is recorded:”

  • Capturing the specific location where the service starts and stops, regardless if that location is in the home or community.
  • Using the terms “home” and/ or “community” as the designation in the EVV system for location, so that the location data element transmitted to the state is indicated as either “home” or “community” but the specific community location would not be transmitted.
  • Capturing only the specific home location, but the start and stop times for the full service unit. Under this option, if a service visit starts in the community and ends in the home, the caregiver would check in from the community to note the visit’s start time (without recording location), check in again when they enter the home to begin recording the location, and then check out when they leave the home to note the visit’s end time.

CMS “takes no position on which option should be selected by a state, or on the technological implications for implementing methods b) or c).”

Some states have been pursuing the idea of using web-based electronic timesheets with dual verification to fulfill the EVV requirements in the 21st Century Cures Act, but the guidance makes clear that such a system would not be a permissible form of EVV. According to the Bulletin, “web-based timesheets alone do not provide the state with auditable confirmation of the data entered by the provider and approved by the individual. Consequently such a system would not be sufficient for electronically verifying the six data elements required by section 1903(l)(5)(A) of the [Social Security] Act for PCS or HHCS services rendered during an in-home visit.”

FMI: The guidance is available at https://www.medicaid.gov/federal-policy-guidance/downloads/cib080819-2.pdf.