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Electronic Visit Verification (EVV) for CDPAP: Understanding Exclusions and Guidelines

Electronic Visit Verification (EVV) for CDPAP:

In December 2016, Congress made a new law called The 21st Century Cures Act. This law said that all State Medicaid programs had to use something called Electronic Visit Verification (EVV) for Personal Care Services (PCS) and home health care services (HHCS), which include CDPAP. If they didn’t, they could lose up to 1% of their funding. New York started using EVV on January 1st, 2021. EVV is a system that electronically checks visits for home or community-based care to stop fraud, waste, and abuse. It collects information like what service was done, who got it, when it was done, where it happened, who did it, and when it started and ended. This system helps make sure care is given the right way and can be checked easily.

In the past few years, the healthcare industry has been using more technology to make care better and faster. One of these new technologies is Electronic Visit Verification (EVV). EVV is a system that keeps track of when and where caregivers visit people who need care, like those in the Consumer Directed Personal Assistance Program (CDPAP). In this article, we’ll learn about the rules and exceptions for EVV in CDPAP in New York State, so we can understand how it works and what it means for people getting care.

What is EVV?

Electronic Visit Verification (EVV) is a type of technology that checks if home and community-based care visits really happen. It makes sure that caregivers give care when and where they’re supposed to, making the care process clearer and more responsible. EVV systems usually use different methods like mobile apps, phones, and GPS to keep track of and confirm caregiver visits.

  • EVV for CDPAP in New York State. 

The New York State Department of Health has set up special rules and needs for using EVV in the CDPAP program. These rules make sure that caregiver visits are recorded and confirmed accurately, while still giving people getting care some freedom and control.

Key Guidelines for EVV Verification in CDPAP

The guidelines provided by the New York State Department of Health for the EVV program offer important rules and expectations for using EVV in the CDPAP program. Here are some key guidelines:

  • Mandatory Use of EVV: Every CDPAP provider must use an approved EVV system to record and confirm caregiver visits. This makes sure that care delivery is documented correctly and follows program rules.
  • Caregiver Training: CDPAP providers have to make sure that caregivers get enough training on how to use the EVV system. This training helps caregivers use the technology well and follow EVV rules.
  • Patient Consent: Before using EVV, providers need to get permission from the person getting care or someone they choose to speak for them. This permission makes sure the person knows about EVV and what it means for their care.
  • Data Security: EVV systems have to follow strict rules to keep caregiver and patient information safe. They have to follow HIPAA rules to make sure that private information stays private.

Compliant Technologies for EVV Data Collection

New York State, following advice from the Centers for Medicare and Medicaid Services (CMS), recognizes certain technologies as acceptable for gathering EVV data:

  1. Telephony: This method uses phone calls to record when services are provided and confirm where they take place. Usually, this is done using a regular landline phone.
  2. Mobile App: With this option, caregivers can use downloadable apps on smartphones or tablets to record service times and locations. Even if there’s no cell service, these apps can still work.
  3. Fixed Object (FOB): These are devices placed in homes with unique IDs that confirm the location of service delivery.

New York State encourages providers and FIs to work together with their EVV vendors to offer different ways to collect EVV data, ensuring that they meet the requirements. EVV systems must use electronic devices that can record all the necessary EVV data points, provide them when needed, and keep the data secure. They should also be available for input or service delivery at any time, have backups for emergencies, and be able to handle various work schedules and multiple people and aides in the same place.

Visit Verification

It’s up to providers, provider agencies, and FIs to make sure that EVV data is collected and checked before they send in a claim or encounter. A verified visit includes all the info required by the 21st Century Cures Act and New York State’s data rules, making sure to handle any visit exceptions before submitting claims. For more information on what’s needed for data submission, you can check out the EVV Technical User Guide and the Interface Control Document (ICD).

Data Submission to NYS EVV Data Aggregator

Every EVV system needs to be able to send information electronically to the NYS EVV Data Aggregator in the right format. Providers or FIs have different ways to send their EVV data to the NYS EVV Data Aggregator. It’s important for them to work together with their submitter, whether it’s a Managed Care Organization (MCO), a vendor, a VO, another aggregator, an in-house solution, or any mix of these, to set up how data will flow and create partnerships that match their specific needs for EVV data submission.

Here are the ways EVV data can be submitted to the NYS EVV Data Aggregator through different entities acting as submitters:

  • Billing Provider Agency/FI: A provider organization/FI that sends EVV records on its own behalf.
  • EVV Vendor: A company that handles and sends healthcare transactions for a billing provider or FI.
  • 3rd Party Aggregator: An EVV aggregator that sends data for multiple agencies.
  • MCO: An MCO that sends EVV data for a contracted provider or FI.
  • VO: A VO that sends EVV data for any other entity.

For more details on what’s needed for data submission, you can check out the EVV Technical User Guide and the Interface Control Document (ICD).

Data Retention

Providers and FIs must keep EVV data for at least seven years from the last date of service. This duration may be longer if required by federal and state laws or contracts with MCOs. If an audit happens within this time, records must be kept until the audit finishes and all issues are resolved, even if the retention period has ended. These rules apply even if the provider or FI stops operating.

Device Management

Providers and FIs need to find other ways for caregivers to record EVV data when electronic devices aren’t available. They should work with their EVV system vendor to find the best technology method(s) that match their needs and the needs of the people they serve.

Device Costs

Providers or FIs are responsible for paying for and setting up an EVV system on their own. Currently, New York State doesn’t help with extra costs for this.

Non-Compliant EVV Methods

  • Providers offering Electronic Visit Verification (EVV) services must ensure that all visits have complete EVV data to be considered verified. If a visit wasn’t electronically captured at the time, the provider agency or Fiscal Intermediary (FI) must explain why a compliant EVV method wasn’t used. This explanation must be kept by the provider agency or FI.
  • The Office of the Medicaid Inspector General (OMIG) or the NYSDOH will keep an eye on the use of non-compliant EVV methods and paper timesheets. It’s up to the provider agency and/or FI to genuinely try to capture EVV through compliant methods.
  • Any changes to EVV data need approval from agency management or CDPAS consumers before being sent to the NYS Data Aggregator. Non-compliant methods, like those related to religious holidays or observances affecting technology use, must be explained and noted down.
  • Providers should pick vendor systems with an offline mode option to ensure EVV data is captured even during power outages or when there’s limited service. The EVV solution should be able to tell the difference between compliant data and non-compliant methods and require a documented reason for any non-compliant entries or changes.
  • Providers must keep all documentation for non-compliant entries in case of audits. If compliance doesn’t improve, the Department might review it, possibly finding overpayments. This highlights how important it is to have thorough documentation and comply with the rules.

Exclusions from EVV Verification

While Electronic Visit Verification (EVV) serves as a crucial tool for maintaining accountability and transparency in care delivery, there are instances outlined in the EVV program guidelines for CDPAP in New York State where EVV verification might not be necessary or relevant. These exclusions delineate particular scenarios where EVV verification may not be mandated or suitable. It’s vital for CDPAP providers and caregivers to understand these exclusions to uphold compliance with program stipulations.

Exclusions from EVV verification may include:

Live-In Caregiver Exemption

Exclusions from EVV verification may encompass various scenarios, with one notable exemption being the Live-In Caregiver Exemption. According to the guidelines set forth by the New York Electronic Visit Verification (EVV) program, an EVV-exempt live-in caregiver is defined as a caregiver offering services to a Medicaid member whose permanent residence aligns with that of the member. This alignment indicates that the caregiver and the member share the same permanent place of residence. It’s crucial to emphasize that residence status verification is essential for both the member(s) and caregiver(s). Furthermore, if an EVV-exempt live-in caregiver provides services to multiple members with whom they permanently reside, the EVV-exempt live-in caregiver status must be validated for each member individually.

Examples of caregivers who do not fall under the EVV-exempt live-in caregiver category include individuals who temporarily live with the Medicaid member while providing services for short durations, such as two weeks. Additionally, caregivers who work 24-hour shifts but whose permanent residence differs from that of the Medicaid member, as seen in “live-in 24-hour” personal care or CDPAP cases, are not considered EVV-exempt live-in caregivers.

The New York State Department of Health (NYSDOH) does not mandate the submission of EVV data for caregivers meeting the criteria of an EVV-exempt live-in caregiver. However, Managed Care Organizations (MCOs), providers, and Fiscal Intermediaries (FIs) have the autonomy to decide independently, based on their business requirements, whether the collection of EVV data for EVV-exempt live-in caregivers is necessary.

Verification of live-in caregiver status may be subject to audits conducted by the Office of the Medicaid Inspector General (OMIG) or NYSDOH. In the event of an audit, acceptable documents demonstrating the same address for both the member and caregiver can verify EVV-exempt live-in caregiver status. These documents may include New York State ID, tax returns, automobile registrations, voter registration cards, utility or household bills, bank account statements, or Medicaid records.

Providers and FIs bear the responsibility of compiling, maintaining, and validating all records justifying the status of each EVV-exempt live-in caregiver for NYSDOH verification and auditing purposes. In cases where there is an address change for either the member or live-in caregiver, providers and FIs must ensure the validation of address change documentation to uphold the validity of the live-in caregiver exemption status. Failure to maintain accurate documentation may result in services becoming subject to EVV requirements. It’s imperative that all address verification documentation between the member and live-in caregiver remains current at the time services are provided to the member.

Training Requirements

Ensuring that caregivers and staff are well-versed in Electronic Visit Verification (EVV) systems is paramount for the effective implementation of EVV programs. Below are the minimum training requirements that provider agencies and Fiscal Intermediaries (FIs) must adhere to when training their EVV system staff and caregivers. It’s important to note that these requirements are subject to change based on federal and state regulations, with EVV training programs expected to meet these standards by October 1, 2021.

Training Requirements

  • Comprehensive Training Delivery: Provider agencies and FIs must provide training to caregivers, agency staff, and EVV system users responsible for submitting EVV data to the New York State Department of Health (NYSDOH). The training may be delivered through various formats, including instructor-led sessions, webinars, or self-service online modules.
  • System User Training: Prior to submitting EVV data to the NYS EVV Data Aggregator, providers and FIs must ensure that system users undergo training. Additionally, annual training refreshers must be provided to all users. Any significant changes to the EVV program necessitate immediate inclusion in the next annual training cycle. Training materials should always be accessible to train new users.
  • Documentation Maintenance: Providers and FIs are responsible for maintaining detailed documentation of all training sessions. This includes records of training materials, attendee lists, and session specifics.
  • Member Engagement: Providers and FIs must confirm that Medicaid members have reviewed and understood the EVV Fact Sheet for Medicaid Beneficiaries and Families. This information should be incorporated into the member’s service plan.
  • EVV Attestation: All providers and FIs required to submit EVV data must have an EVV Attestation on file with NYSDOH. This attestation confirms that necessary training has been provided to all required users.
  • Policy Familiarity: Providers, FIs, agency staff, data submitters, and caregivers should familiarize themselves with the policies outlined in the Program Guidelines and Requirements document.
  • Inclusion of EVV Stipulations: Training sessions must cover EVV stipulations outlined in the 21st Century Cures Act and New York State program information. Participants should be informed of where to find this information on the NYS EVV website.

By adhering to these training requirements, provider agencies and FIs can ensure that caregivers and staff are equipped with the knowledge and skills necessary to effectively utilize EVV systems, thereby enhancing accountability and transparency in care delivery.

Training Requirements

Provider agencies and Fiscal Intermediaries (FIs) are obligated to adhere to minimum training standards when educating their Electronic Visit Verification (EVV) system personnel and caregivers. These EVV training prerequisites remain subject to potential modifications in accordance with federal and state mandates. By October 1, 2021, EVV training programs must align with the following criteria:

  • Comprehensive Training Coverage: All providers and FIs must deliver training sessions to caregivers, agency staff, and EVV system users responsible for submitting EVV data to the New York State Department of Health (NYSDOH). These training sessions may be conducted through various formats, including instructor-led sessions, webinars, and self-service online modules.
  • Pre-submission Training Mandate: Before a system user submits EVV data to the NYS EVV Data Aggregator, providers and FIs must ensure they undergo training. Additionally, annual training refreshers must be provided to all users. In instances where significant alterations are made to the EVV program, training on these modifications must be integrated into the subsequent annual training cycle, if not sooner. Furthermore, training materials must always be readily accessible to facilitate training for new users in roles that necessitate EVV utilization.
  • Documentation of Training Activities: Providers and FIs are required to maintain meticulous records of all training activities. This entails documentation of the following:
    • Training materials and content
    • A comprehensive roster of caregivers and staff system users, inclusive of details such as:
      • Specific training sessions attended by each individual
      • Dates of attendance for each training session
      • Format of each training session (e.g., in-person, online, etc.)
      • Dates of completion for each training session
  • Member Acknowledgment: Providers and FIs must ensure and document within the member’s service plan that Medicaid beneficiaries have reviewed and comprehended the EVV Fact Sheet designed for Medicaid Beneficiaries and Families.
  • EVV Attestation Requirement: Providers and FIs mandated to submit EVV data must possess an EVV Attestation, confirming that requisite training has been provided to all relevant users. This documentation must be retained on file with NYSDOH.
  • Familiarity with Program Policies: All providers, FIs, agency staff, data submitters, and caregivers must be well-versed with the policies delineated in the Program Guidelines and Requirements document.
  • Incorporation of EVV Stipulations: Training sessions must incorporate EVV stipulations outlined in the 21st Century Cures Act and NYS program information. These sessions must also specify where these stipulations and information can be accessed on the NYS EVV website.

Provider’s EVV System Training Requirements for Caregivers should encompass:

  • Overview of Provider’s System and Workflows (non-technical)
  • Instructions for electronically collecting EVV data using the Provider’s system and associated device(s)
  • Guidance on manual EVV data collection protocols and documentation requirements
  • Procedures for documenting Live-in caregiver information
  • Protocols for electronically collecting EVV data in scenarios involving multiple caregivers or beneficiaries
  • Steps for transmitting data to the Provider’s System
  • Information to be communicated to Medicaid beneficiaries and their families regarding EVV

All providers and FIs should refer to NYSDOH’s Interface Control Document (ICD) and EVV Technical User Guide for crafting training materials covering the following topics:

  • NYS Choice Model
  • Provider/fiscal intermediary’s system overview and workflows
  • EVV System Security
  • Protocols for transmitting data to NYS
  • Fraud prevention measures through accurate EVV data collection
  • Technical support resources, including the NYS eMedNY Helpdesk Phone Number for Technical questions: 1-800-343-9000.

Best Practices for EVV Implementation

In addition to understanding the guidelines and exclusions related to EVV verification for CDPAP, providers and caregivers can benefit from adopting best practices to ensure effective implementation and compliance. Some best practices include:

1. Clear Communication: Providers should communicate with caregivers and individuals receiving care to ensure a clear understanding of EVV requirements, exclusions, and implications for care delivery.

2. Regular Training and Support: Ongoing training and support for caregivers in using the EVV system can enhance compliance and accuracy in recording caregiver visits.

3. Documentation and Reporting: Providers should maintain detailed documentation of EVV exclusions, exceptional circumstances, and alternate verification methods. Accurate reporting of such instances is essential for program compliance.

4. Continuous Monitoring and Evaluation: Regular monitoring and evaluation of EVV implementation can help identify areas for improvement and ensure consistent adherence to program guidelines.

Electronic Visit Verification (EVV) plays a crucial role in enhancing transparency, accountability, and accuracy in caregiver visits within the CDPAP program. By understanding the guidelines, exclusions,

FAQ: Questions to Ask a Fiscal Intermediary about EVV

When evaluating a Fiscal Intermediary’s (FI) EVV program or considering a new FI for CDPAP, it is essential to ask pertinent questions to ensure that the EVV system aligns with program requirements and meets the needs of caregivers and individuals receiving care. Here are some key questions to consider:

1. What EVV technologies do you offer?

  Understanding the range of EVV technologies available through the FI is crucial for selecting a system that best suits the needs of caregivers and individuals receiving care. This may include mobile applications, telephony-based systems, or other electronic verification methods.

2. What are your offline/emergency options (i.e., alternative technology, offline mode, paper timesheet)?

 Inquire about the FI’s contingency plans for offline or emergency situations where electronic verification may not be feasible. Understanding the availability of alternative technology, offline modes, or paper timesheets can provide insight into the FI’s preparedness for unexpected circumstances.

3. Do you use GPS location tracking?

GPS location tracking can be a valuable feature in EVV systems for accurately verifying caregiver visits. Understanding whether the FI utilizes GPS tracking can offer transparency and accountability in care delivery.

4. Is your EVV vendor in-house or outsourced, and is the technology secure?

 Understanding the source of the EVV technology and its security measures is essential for safeguarding sensitive caregiver and patient information. Inquiring about the in-house or outsourced nature of the EVV vendor and the technology’s security protocols can provide assurance regarding data protection.

5. What are your procedures if I cannot use technology due to religious reasons?

 Recognizing and respecting religious considerations related to technology use is important in ensuring inclusivity and compliance with individual beliefs. Inquiring about the FI’s procedures for accommodating caregivers who cannot use technology due to religious reasons can demonstrate sensitivity to diverse cultural and religious practices.

6. Will consumers, designated representatives, and personal assistants be offered initial and ongoing training in an accessible format?

 Ensuring that individuals receiving care, designated representatives, and personal assistants receive comprehensive training in an accessible format is crucial for effective EVV implementation. Inquiring about the availability of initial and ongoing training can support caregivers in utilizing the EVV system effectively.

By asking these questions and seeking detailed information from Fiscal Intermediaries, caregivers and CDPAP participants can make informed decisions regarding

the selection of an EVV system and FI. Open communication and a thorough understanding of the EVV program’s components are essential for ensuring compliance and optimizing the care delivery process.

7. How will the implementation of EVV affect caregivers and the individuals receiving care?

 The introduction of Electronic Visit Verification (EVV) aims to enhance transparency and accountability in care delivery. For caregivers, this means adopting new processes for documenting their visits and ensuring compliance with EVV requirements. It may involve using specific electronic systems or devices to record accurate time and location data for each visit. While this may initially require some adjustment, it ultimately contributes to a more robust and verifiable record of care provision.

For individuals receiving care, EVV serves as an additional layer of assurance regarding the services they receive. It provides a mechanism for verifying the duration and quality of care, ultimately promoting greater peace of mind and confidence in the care delivery process. By leveraging EVV data, individuals and their families can gain insights into the consistency and reliability of care services, thereby fostering an environment of trust and accountability.

Conclusion

As the implementation of Electronic Visit Verification (EVV) becomes increasingly prevalent in programs like the Consumer Directed Personal Assistance Program (CDPAP), it is crucial for caregivers, individuals receiving care, and Fiscal Intermediaries to have a comprehensive understanding of EVV guidelines, exclusions, and best practices. By adhering to program requirements, asking pertinent questions, and fostering effective communication, stakeholders can contribute to the successful implementation of EVV, thereby enhancing transparency, accountability, and quality of care.

Through the exploration of EVV guidelines, exclusions, and the FAQ section for engaging with Fiscal Intermediaries, this article aims to provide valuable insights into the EVV verification process for CDPAP in New York State. By leveraging this knowledge, caregivers and individuals receiving care can navigate the EVV program with confidence, ensuring that care delivery remains efficient, compliant, and aligned with their unique needs.

In summary, Electronic Visit Verification (EVV) holds immense potential to transform and elevate the standards of care delivery, and by understanding its intricacies, stakeholders can harness its benefits while ensuring the integrity of the care provided.

Sources: Electronic Visit Verification (EVV)