EVV Regulations, Decoded: How to Prepare Now for the EVV Mandate

Personal care agencies have blazed the trail with Electronic Visit Verification (EVV) - and now the impact to Home Health providers is upon us. The Cures Act deadline of January 1, 2023, for Home Health providers is right around the corner, requiring states that have not yet implemented EVV for home health to act quickly. Only a third of states have already enacted EVV regulations for home health, however, the vast majority of states are working to meet the challenge this year.

There is good news for providers who will be newly impacted by the EVV mandate in 2022. At this stage, EVV implementation has already been “road tested”. Many state and MCO payors have already made significant progress on both defining requirements for EVV and fine-tuning their approach to implementation. This is a significant opportunity for home health providers to take advantage of lessons learned and streamline their own EVV rollout.

So, how should home health providers get started? First, understand the requirements and how they affect your agency. Second, start planning now. As you define your compliance approach, do so with a focus on caregiver support, and an emphasis on implementing a straightforward back-office workflow.

EVV Requirements Vary By State

As a starting point, let’s frame-up EVV regulations to understand the impact on the agencies it governs. The first point to understand is that, while federal mandates dictate the use of EVV, states still determine most aspects of implementation. As a result, compliance requirements can and do vary by payor. With the signing of the Cures Act in 2016, the Federal regulation set the stage, requiring the Medicaid-funded Personal Care Services and Home Health Services to be electronically verified. This legislation established a minimum set of six data points that must be collected for each service, as well as a requirement to implement no later than January 1, 2021 for Personal Care (provided the state receives a good faith exemption) and January 1, 2023 for Home Health. States are required to meet these basic requirements of the mandate, but beyond that have the latitude to decide how EVV is implemented for their constituents.

Providers must meet requirements for each state they operate in and each payor they bill to. States have different requirements from each other, and state and MCO payors can also have different requirements within the same state. So, if you are billing multiple lines of services, or if your agency operates branches in more than one state, you must comply with each unique set of requirements.

Each state determines EVV policy and sets guidelines for implementation, which can encompass multiple factors. States establish parameters for EVV rollout, which include:

• Determine services impacted by the EVV mandate. Each state determines which services are subject to EVV and creates a list typically at the procedure code level. If your agency delivers services on that list, you will be required to electronically verify the relevant visits. Given the breadth of waivers included in many state lists, agencies outside of the traditional personal care or home health delivery space have been impacted. For example, some states have included behavioral health, autism, I/DD, and respite services, or required EVV for some visits conducted via telehealth. Most aides that deliver personal care services have already been required to use EVV, but increasingly visits delivered by an RN/LPN can be affected as well.
• Create policy guidelines. States, with the help of stakeholders, establish policy guidelines that govern EVV, such as whether live-in caregivers are exempt from EVV or how GPS can be used to validate the location of service delivery.
• Choose the state technology solution. Each state also chooses its own technology solution – both selecting a vendor, establishing requirements for provider systems, to determining how services are billed.
• Establish EVV implementation timeline. States set the timeline for implementation by providers and often require agencies to meet certain compliance milestones along the way.

At the outset, providers face a myriad of varying requirements from 50 states and numerous MCO aggregators when deciding on an approach to EVV. Compounding the complexity, state and MCO requirements can evolve over time. We have seen a lot of movement in requirements - for example, updates to data specifications from the state or MCO aggregator, establishment of a new aggregator, or a requirement to follow a specific billing process. 

Getting Started: Determine the Impact of EVV to Your Agency

One common question that providers often ask is “How do I know if I am affected by the EVV regulations?” There are two primary criteria that will help you determine how and whether EVV impacts your agency:

1. Medicaid-funded. If you bill mandated personal care or home health services to Medicaid, EVV is required.
2. State Services List. Each state determines the services subject to EVV. Your state will create a list, by service code, of impacted services. You can check your list of billed services against the required list to determine how many, if any, services require EVV.

As a reminder, an agency’s classification or agency type does not determine whether EVV applies. Instead, it’s simply whether that agency delivers services that are covered by the EVV mandate in their state. Just because an agency is primarily a “hospice” or “behavioral health” provider does not guarantee that EVV is not required. Participant-directed services are also required by the federal legislation, however, many states exempt caregivers that live with their patient, who might be a family member.

Compliance 101: Provider Responsibility

When EVV applies, providers have two obligations with respect to EVV. The first, to collect correct, compliant EVV information at the point of care. And the second, to relay that information to the state and MCO payors who require it. As we discussed earlier, each state or MCO payor has specific EVV requirements unique to their implementation. Agencies must provide the right EVV data required by the state- in the right format, often in near real time for claims matching.

Determine Your Compliance Approach

So now that you understand much of what’s required, where do you go from here? First and foremost, our experts would recommend that you get started now. Use this time to set priorities for your agency, and to select a solution that fits your specific needs. We consistently see two key priorities bubble to the top for providers who are beginning their journey with EVV: Making it easy for caregivers, and streamlined operations and simplified workflow.

Subscribe to our Blog for more insights on EVV. And, contact CellTrak for guidance along the way. We are here as your resource.