The next big phase of the 21st Century Cures Act has a Jan. 1, 2023 deadline for implementation, creating some buzz as we get closer. This phase requires all states to implement Electronic Visit Verification (EVV) for all Medicaid-financed home healthcare services.
As the deadline looms, there’s a bit of a scramble to find and implement fully integrated homecare management software to be compliant, and some states are even applying for extensions.
We see first-hand how the industry prepares for this phase of the Cures Act and have some pretty interesting observations. This deadline is a big deal, as failure to meet it will reduce federal Medicaid funding for non-compliant states.
Below we discuss the implications of the pending EVV deadline while elaborating on the law’s implementation guidance, exploring how technologies can be utilized to quickly obtain legal compliance, what this new phase will mean for the overall landscape of homecare, and what to expect post-deadline.
Q: Tell us a bit about HHAeXchange.
A: At HHAeXchange, we connect providers, state Medicaid programs, managed care organizations (MCOs), and caregivers through one platform. This connection breaks down barriers in care and enables better efficiency, communication, transparency, and compliance.
We believe that healthcare should be simple, effective, and transparent, and have made it our mission to provide better outcomes for the millions of individuals receiving home and community-based services (HCBS).
Q: What is the 21st Century Cures Act EVV Compliance Deadline and when is it?
A: At large, the 21st Century Cures Act, passed in 2016, was designed with an aim to eliminate bureaucratic obstacles that result in patients waiting too long for treatment and advanced cures.
But an act this comprehensive in nature could not be implemented all at once, so various compliance deadlines were set for different phases of the new legislation. As of January 1, 2023, states will be required to implement electronic visit verification (EVV) for Medicaid-financed home health care services (HHCS). Adherence to this rule helps to ensure that home health care workers arrive on the job and complete the approved tasks – but the law doesn’t provide detailed implementation guidance. That’s where HHAeXchange comes into play. In addition to providing states with fully integrated homecare management software, we also work with them to ensure full compliance, increases in efficiency and productivity, streamlined workflows, and greater visibility and insights by all parties, resulting in better member outcomes.
Q: What does EVV entail?
A: Different states have different requirements for EVV communications. EVV is essentially a technology that verifies the date, location and type of service performed, names of service provider and patient, and the beginning and end times for service visits.
Depending on which platform a homecare agency utilizes for EVV, they might also use the technology for streamlining business processes, such as billing, payroll, care plan communication, and other operational functions.
Q: Why is EVV necessary?
A: EVV is critical in the homecare space for a variety of reasons. For starters, it’s a way to provide documentation that becomes the basis for billing and proves that a member received care. EVV also improves billing accuracy while preventing fraudulent charges, Medicaid system waste and abuse, and gaps in care by giving providers, care coordinators, and oversight organizations access to real-time data collected at the time services were rendered.
Q: Who needs to comply with the EVV implementation deadline?
A: All states are required to implement EVV for Medicaid-financed home health and personal care services (PCS). Agencies delivering services must have the technology in place – either a state-offered EVV system or their own EVV system – to connect to the state’s system and upload data. We understand that homecare service providers are being asked to keep up with a multitude of changes and ensure compliance amid a torrent of new regulatory requirements, and that can be a lot all at once, especially for overloaded agency owners who are already dealing with the demands of running a business. The Centers for Medicare and Medicaid Services (CMS) have some good resources for those who need additional guidance, including this handy FAQ document. We recommend agencies refer to it as needed.
Q: What are the penalties for failing to become EVV compliant?
A: States that fail to comply are subject to incremental Federal Medical Assistance Percentage (FMAP) reductions up to 1%. Penalties may apply to any agencies not adhering to EVV regulations, and their Medicaid claims will not be accepted by their respective states. Agencies may even have their Medicaid contracts canceled. However, the goal of this legislation is not to punish homecare agency owners or weed anybody out. Getting an EVV platform in place isn’t challenging, and once you’ve chosen one, things will begin to fall into place. A good platform will actually make life easier by streamlining business operations in addition to offering EVV.
Q: Can agencies be reimbursed by the government for administrative costs for providers or MCOs to contract with their preferred EVV vendors?
A: No. CMS does not have authority to provide enhanced federal match for administrative costs for providers or MCOs. In some instances, providers may incur costs to purchase EVV devices and/or equipment themselves. In those instances, the costs associated with the purchase of the EVV materials could be built into the rate paid to the provider for the rendering of services. Agencies can check with their CMS Regional Office for assistance on provider payment rates. However, a lot of agencies will find that EVV platforms basically end up paying for themselves in the form of saved time and money, increased efficiency, improved scheduling, record organization, and more benefits.
Q: Are EVV compliance deadline extensions available?
A: CMS offers an exemption to most states in accordance with section 1903 (1) (4) (B) of the Social Security Act and by section 12006 (a) of the 21st Century Cures Act. States that request an extension must have made a good-faith effort for complying with EVV requirements through conducting environmental scanning, choosing an EVV model, and enhancing their current EVV system to meet the compliance needs of the federal government. Basically, a state trying to comply within the provided time but encountering unavoidable delays may receive an extension. If a state has met the compliance deadline, then all agencies in that state must be compliant as well.
Kim Glenn, Senior VP Government Health Plans, HHAeXchange, the leading provider of homecare management solutions for providers, managed care organizations, and state Medicaid agencies