Get the latest updates on state EVV mandates.

CMS Confirms EVV is Subject to HIPAA

In a July 2018 letter to ANCOR, CMS (Centers for Medicare & Medicaid Services) confirmed EVV systems “are subject to HIPAA privacy and security protections”. HIPAA compliance will impact the range of EVV systems available to providers to choose from. As not all vendors will permit PHI (Protected Health Information) to be stored at their data centers, EVV systems need to comply with three sets of regulations:

  • The 21st Century Cures Act
  • Additional state-regulations
  • HIPAA

The identity of clients, services delivered, and documentation will need to be protected by technical security that meets HIPAA standards, as well as HIPAA training for staff managing EVV PHI data at both the provider and software vendor.

For more information on EVV compliant time and attendance solutions, download the myAttendance fact sheet. In addition, providers need to consider BYOD (Bring Your Own Device) policies. For more information, download this eBook, How Agencies Should Implement a BYOD (Bring Your Own Device) Program.

EVV Officially Delayed

The 21st Century Cures Act of 2016 had initially carried an implementation deadline of January 1, 2019 on EVV requirements. On Monday, July 30, 2018, the President Trump signed H.R. 6042 into law, which delays for one year the reduction of Federal medical assistance percentage for Medicaid personal visits furnished without an electronic visit verification system. States now have until January 1, 2020, to begin compliance with the EVV law. States can also apply for a good-faith extension that would extend the deadline until January 1, 2021.

While this comes as a relief to providers across the nation, it important that all parties stay diligent in working with their state to secure systems that will suite their needs while meeting mandated requirements. Fortunately, the legislation signed into law this week mandates that input from the public is solicited to help ensure the thoughtful implementation of the EVV requirement.

This eBook reviews the different EVV solutions states have adapted, as well as their successes and failures. Most importantly, it arms providers with key questions they need to ask to ensure the state understands the practical issues that can arise from an EVV mandate.

When Rounding Rules Differ Between Billing and Payroll

In some states with EVV mandates, providers are losing money because they must pay their employees more than than can bill for. This happens when rounding rules in the EVV legislation differ from payroll rounding rules set by the labor department.

Most programs will only pay for services in 15-minute increments, but EVV solutions capture exact clock-in/out times. This means that if a caregiver clocks out at 11:14, the provider may not be allowed to bill the last 14 minutes – even though DOL regulations require the provider to pay the employee for those minutes.

Recapturing “Missing” Minutes

“Missing” minutes are those extra minutes that do not add up to a billable unit. While some states don’t allow providers to capture “missing” minutes, Missouri does. The state’s EVV legislation says:

“In no way shall this rule prohibit the
vendor/provider’s ability to accrue partial units pursuant to 13 CSR 70-91.”

The Missouri Department of Social Services says providers may let these minutes accrue until they add up to billable units. For example, if a caregiver works 143 minutes in a billing period, the provider will bill 9 units and rollover 8 minutes to the following period.

Unfortunately, providers who cannot rollover minutes to the following billing period must find creative ways to reconcile rounding discrepancies. For example, an EVV system like Agency Workforce Management warns employees to not clock-out before a unit is complete. The system may suggest that the employee wait a few more minute to clock out.

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Does the EVV legislation in your state include different rounding rules? How do you avoid paying for more than you can bill?

EVV Challenges for Consumer Directed Services

Consumer-directed services offer the independence many individuals desire, while ensuring they get the care they need. However, these services fall under the reach of the federal EVV mandate. Because of their unique requirements, providers managing programs for consumer- or family-directed services face real compliance and billing challenges that complicate EVV implementations.

The purpose of CDS programs is to allow individuals to drive their own care. Therefore, an EVV system cannot compromise the consumers’ ability to do so. Two primary challenges that consumers face with EVV systems are ease of use and ability to approve timesheets. These hurdles cannot be overlooked when considering an EVV system.

Challenge #1: Ease of Use

An EVV system’s ease of use is essential in CDS programs because EVV success depends heavily on the client. Applied Self Direction, an arm of the National Resource Center for Participant-Directed Services, notes, “Technology is an essential tool, but people need to know how to use the tool to realize its benefits.” If consumers do not understand the EVV system, they will not enjoy its advantages.

The Consumer Directed Personal Assistance Association of New York State (CDPAANYS) reinforces this view. In its recent report on EVV, the association states the importance of usability for an effective EVV system:

“In the end, an EVV system can only be as effective as your consumers and their PAs willingness, ability, and capacity to utilize it. Therefore, FIs should seek input from established groups of consumers before a system is chosen and implemented. When choosing a system, recognize that accessibility is a critical component, and that consumers and their PAs, like the rest of us, value highly both flexibility and privacy.

“Most importantly, it is important to remember that CDPA is based on the notion that the consumer, not an agency, recruits, hires, trains, supervises (including scheduling), and terminates their own staff. Any EVV solution must provide for a strong role for the consumer and the continued ability to perform these supervisory tasks.

“If this is accomplished, EVV can serve as not only a compliance with Federal mandates, but an effective means to efficiently track time and attendance and submit billing, streamlining operations and increasing responsiveness; a value to all.”

Challenge #2: Client Approval of Timesheets

Another obstacle is ensuring the billing process is prompt and accurate. Unlike traditional HCBS settings, this requires input from the consumer. As the director of his/her own care, the consumer must approve employee time and attendance records before they are converted into billing and payroll records. The problem is that not every EVV system has this capability.

Providers managing CDS programs must consider an EVV system’s capacity for client access before deciding to implement it. “A successful EVV system will provide a variety of accessible means for individuals to approve service hours, using both innovative and standard technologies,” according to Applied Self Direction. Such a system would allow mobile access for clients and/or their guardians to approve timesheets, communicate efficiently with employees, and make corrections when mistakes occur.

Explore Agency Workforce Management for CDS Programs

Fortunately, Agency Workforce Management is designed to support providers managing self-directed programs. Here are some ways our software may help you succeed under an EVV mandate:

  • Consumers

    • Review real time or after-the-fact multiple attendant attendance records
    • Includes Caller-ID, GPS or IP address information
    • Approve visits with option to add comment next to any visit
    • Automatically remind consumers, guardians or parents and provider if consumer fails to approve attendance in a timely manner
    • Reports of approved and unapproved records by consumer
  • Schedules

    • Review attendant schedules
    • Use calendar to check schedules
  • Attendants

    • Clock in/out using EVV compliant systems (landline or smart phone)
    • Enter documentation
    • Review attendance, schedules and more
    • Receive daily next shift reminders
  • Payroll

    • Eliminate the costs and risk of paper forms and data entry
    • Integrates with payroll
  • Billing

    • Streamline billing and improve cash flow
    • Integrates with billing

Who Approves Alternative EVV Systems?

Providers who supposedly have the freedom to choose alternative EVV vendors over state systems are starting to wonder whether the process is actually feasible.

Some states have chosen a “hybrid” implementation model, in which providers may use the free state-contracted system or another system that meets requirements. This solution serves to mollify providers who are unhappy with the state system, but some of those providers find it nearly impossible to get an alternative system approved.

Ohio EVV UpdatesOhio, for example, has a contract with Sandata to provide a state-wide EVV solution beginning January 2018. The state claims providers can use their own vendor instead of Sandata. However, providers who start that process are connected with a Sandata representative. The state offers an “EVV Provider Hotline” which directs to Sandata. Emails to EVV@medicaid.ohio.gov receive replies from Sandata. In other words, Sandata has the ultimate power to approve or deny competing vendors.

Texas EVV UpdatesThe situation in Texas is similar. DataLogic Vesta, which operates the statewide system, must approve any alternative EVV system that providers want to use. Will DataLogic Vesta’s profits suffer if it approves alternative vendors? If so, will the company let any other vendor take away its customers without an extremely burdensome process?

Lack of Clarity in Some States

Many other states do not clarify which organization or agency approves alternative vendors. In Louisiana, Florida, Indiana, and Nebraska, alternative EVV systems must integrate with the statewide system. It is not yet clear how straightforward the integration requirements are.

Colorado EVV UpdatesThe difficulty in predicting problems providers might face is that each state implements EVV in a different way, even if it uses the same vendor as another state. Colorado, like Ohio, has a contract with Sandata for a statewide EVV system, but that doesn’t necessarily mean the situation is identical. Colorado says providers are free to use any EVV system they choose, as long as it meets federal guidelines and is capable of communicating with Sandata through a data aggregator. The state does not specify whether Sandata needs to approve the alternate system.

Good Examples of Provider Choice

Virginia EVV UpdatesA few states appear to have a relatively easy approval process. Virginia declared that “Virginia Medicaid does not and will not approve EVV vendor systems…it is the responsibility of the provider to ensure that it meets Virginia Medicaid’s requirements.”

Missouri EVV UpdatesMissouri says it will obtain “a vendor neutral aggregator system to compile all data” from providers’ various EVV systems. The aggregator system “will allow the state to maintain quality oversight while providing flexibility in vendor selection.”

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Has your organization chosen to use an alternative vendor? What was your experience? Let us know in the comments!

Louisiana Providers Shoulder Unnecessary Costs

Louisiana providers are struggling with the costs of the state’s EVV requirement. Although the 21st Century Cures Act allows telephony to verify visits, Louisiana declared that providers must use mobile devices with GPS functionality. And, whether they use the state system or an alternative one, providers must bear the cost of the technology themselves.

Some providers, especially those with many employees, expressed apprehension about the massive cost of the mobile devices. On March 23, 2018, the Department of Health answered these concerns saying: “The state is providing the EVV system free of charge to providers. It is set up to be accessed from a device with internet access (smart phone, tablet, or computer). A provider agency who decides to provide the device for login should consider getting one device per participant, not per DSW.”

The state has not taken any further steps on the matter. Providers that do not spend what is necessary to comply with the EVV mandate may receive Medicaid reimbursements.

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Do you think states should ban telephony for EVV? Should providers bear the cost of the mobile devices or should they ask employees to use their own?

The True Cost of State-Mandated Systems

As organizations and associations debate the various EVV implementation models, provider choice is strongly preferred across the board by providers who don’t want to get stuck with a limited and out-dated state system. Nevertheless, some states procure a state-mandated system without allowing alternative vendors. The only benefit for agencies in this model is that the system is free. But as it turns out, even that isn’t quite true.

State-mandated systems carry many hidden costs. The top three, according to agency feedback, are devices, inefficiency, and redundancy.

The Cost of Devices

Louisiana EVV UpdatesSome states choose to put the cost of devices on the provider. Louisiana providers have no choice but to use the statewide system, which itself is free but requires mobile devices to function. Providers must bear the cost of the mobile devices themselves. And not just the devices, but also the data plans to operate them.

To manage this requirement, some providers use a BYOD (bring your own device) policy. However, a Louisiana provider told MITC: “We are losing seasoned staff who are very good at their jobs because they cannot afford the device and data plan required. Instead of being able to focus on the service provided they feel overwhelmed.”

The Cost of Inefficiency

According to reports from providers, most of the state-mandated systems are inefficient. They rarely have strong reporting capabilities, lack payroll integration, comprehensive training, or even documentation capture. They don’t integrate with other workforce management tools like scheduling software. These shortcomings raise the likelihood of errors like under- or over-billing.

The Cost of Redundancy

A lot of providers manage multiple programs – some are required to use EVV and others are not. When providers have a state-mandated system for some of its programs, they must use another system for their other programs. This causes an immense load of redundant data entry. Payroll, in particular, is a nightmare!

Most providers prefer to use the same software vendor across all programs. When states allow providers to choose an EVV vendor, they can often use their existing software or find something that works for the entire agency. But when states mandate a vendor, a lot of providers are stuck using two systems. As a result, they have to pay more overtime or hire people to complete all the extra work.

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If your organization uses a state-mandated system, tell us your experiences! Do you have to provide mobile devices and data plans? What other hidden costs have you encountered?

Nevada Yet to Decide Whether Providers Can Continue Using Current EVV Systems

Nevada announced it will mandate a single system for all Nevada providers. However, the state has not decided whether providers who currently use EVV systems may continue to use them instead of the statewide system.

Nevada Medicaid says providers will be able to use the state’s system free of charge. However, many state-mandated systems incur unforeseen expenses upon providers.

The RFP opened to EVV vendors on May 30, 2018. The anticipated contract start date is August 14, 2018.

Virginia Announces Provider Choice Model

Virginia has not finalized its EVV requirements, but it has announced that all providers must choose and implement an EVV system that works for them by January 1, 2019. The chosen system must comply with Virginia Medicaid’s reporting requirements:

  • The system must verify the attendant onsite with GPS or caller-ID
  • The system must maintain records for 6 years

Virginia Medicaid will have several system edits/audits (as detailed in the FAQ):

  • Standard edit processes such as member and provider eligibility
  • Verifying the claim or encounter is supported by and consistent with EVV data
  • Verifying the claim is supported by and consistent with a service authorization
  • Pricing the claim using the appropriate rate for the procedure code submitted
  • Checking for duplicate or overlapping service

Providers will have 60-90 days after the implementation deadline to test and refine the solution.

Why Provider Choice is the Best Choice

So far, the provider choice model (or the open vendor model) is the most successful EVV implementation model country wide. It allows providers to choose the EVV system that best meets their needs and it is minimally disruptive. For the many providers who manage programs that do not require EVV as well as programs that do, the provider choice model enables them to use the same workforce management software across all programs.

However, a few states continue to opt for state-mandated systems. Louisiana, for instance, implemented this model twice only to fail both times. Louisiana finally came around to the reality that every provider has different needs, but not without causing huge disruptions during those first two implementation attempts.

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What are your thoughts on the provider choice/open vendor models? Do you agree that provider choice is the best choice?

North Dakota Wraps Up Stakeholder Meetings

North Dakota held three public meetings for providers to submit input on the upcoming EVV implementation. The last meeting occurred June 5, 2018 – the state has not made any announcements since then.

In February 2017, North Dakota solicited information from potential EVV contract bidders. CMS indicated that North Dakota has chosen the open vendor model, but this information is not confirmed on the state’s websites.