The 21st Century CURES Act was passed by both chambers of Congress and signed into law by President Obama on December 13, 2016. It includes a provision that will affect every personal care services provider by January 1, 2019 and every home health care services provider by 2023.
Section 12006 of CURES directs states to require the use of an Electronic Visit Verification system for all directly and indirectly federally funded in-home services. This will include Medicaid, Managed Care, and Medicare participants. Only 100% patient-pay services will be unaffected.
Click here to read the entire bill. (Search for section 12006)
As each state debates, votes on, and implements its chosen model to comply with the EVV mandate, we will track and report on their progress in these pages. We will be assisted in this 18-month effort by the Partnership for Medicaid Home-Based Care. (See Sidebar for current member list; or medicaidpartners.org for updates.)
For this introductory article, we spoke with PMHC members Tom Underwood, CEO of Sandata, and Addus COO Darby XXX. In future installments, we will hear from other PMHC representatives and various state Medicaid officers.
The Affordable Care Act created new taxes to pay for some of its subsidies. To balance costs not covered by those taxes, the ACA also relies on savings that can be derived by reducing the amount of fraud, waste and abuse in the Medicare and Medicaid insurance system -- including state and federally supported Managed Care Organizations and the Medicare Advantage program. By signing into law an EVV mandate just a month before leaving office, President Obama gave investigators one more tool to identify waste and abuse and, as is their habit, characterize it as fraud.
Under the CURES Act mandate, states are given flexibility to implement EVV in a model of their choosing, as long as their model system satisfies meets certain minimum standards. An EVV system must verify:
States that meet these requirements will receive supplemental federal payments covering 90 percent of the cost of implementing and managing their EVV system. States that fail to create an EVV system will receive gradually decreasing federal support.
As of this writing, 18 states have mandated EVV in one form or another. Some of the other 32 may move forward in advance of the 1/1/19 deadline. Many will likely wait until closer to the deadline.
According to PMHC, there are different models for implementing mandatory EVV but only one that the organization finds acceptable. Unfortunately, they say, some early adopting states have made critical, even fatal, mistakes by implementing their mandate before receiving input from the industry.
At issue is the controversial practice of designating a single vendor as the only approved EVV provider for all of the state's Medicaid home health providers. After this model proved extremely problematic in New Mexico, Texas, Kansas, Oklahoma, Louisiana, Kentucky, South Carolina, Connecticut and Rhode Island, other states got the lesson and came up with something more workable.
In coming weeks, we will examine four models that the 18 pioneer states have used and will analyze the pros and cons of each one. Over time, we will also keep an eye on the rest of the states as they reveal their plans to comply with the mandate. This will be a large undertaking so we are open to receiving help from our readers in every state. When you hear your Medicaid office beginning to make EVV plans, please let us know.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com