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?