FAQs and Definitions
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FREQUENTLY ASKED QUESTIONS (FAQs)
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Biometrics - A measurement of people's unique characteristics; a technology used for identification and controlling access. Some forms of biometrics include fingerprints, face recognition software, eye or retina scans, voice verification and others.
Consumer - A person receiving care or services.
Consumer-directed services (CDS) - A unique Medicaid program or waiver where the consumer has the right and ability to determine who assists them with their needs, when those needs are provided for, and how the work is done. Under CDS, the consumer is the direct employer and responsible for recruiting, hiring, training, scheduling, supervising and terminating or firing their own independent providers.
CMS - The Centers for Medicare and Medicaid Services (CMS) is the federal agency that oversees federal healthcare programs, such as Medicaid and electronic visit verification. CMS is responsible for providing minimum guidelines and regulations for states to follow.
Cures Act - The 21st Century Cures Act is a federal law that was signed by President Obama on December 13, 2016. This law was designed to speed up the development of medical products and provide new treatments to patients more quickly. Within the Cures Act is a section requiring the use of electronic visit verification (EVV) for all Medicaid-funded home care services and personal care services.
Electronic visit verification (EVV) - An electronic method to verify that personal care providers arrived to or left their work site in a private home setting.
Fiscal intermediary - A third-party organization that receives money from Medicaid to pay to independent home care providers on a consumer's behalf. They are typically responsible for processing time sheets, completing payroll services, sending out pay checks to providers, handling all tax and benefits administration, and other services. See also: Fiscal management agency
Fiscal management agency - A third-party organization that receives money from Medicaid to pay to independent home care providers on a consumer's behalf. They are typically responsible for processing time sheets, completing payroll services, sending out pay checks to providers, handling all tax and benefits administration, and other services. See also: Fiscal intermediary
Fixed visit verification - A form of electronic visit verification; a small device that is typically battery operated and stays within the consumer's home. When a provider arrives, they press a button on the device to generate a 6-digit code. This code correlates to the consumer, location and time of day. The code is provided to a third-party, usually by telephone. Fixed visit verification devices do not use biometrics or GPS tracking.
Fourth Amendment - The Fourth Amendment of the U.S. Constitution protects people from unreasonable searches and seizures by the government; and is often argued as protecting our right to privacy. It requires a warrant and probable cause in the event of searches and seizures. The Fourth Amendment reads: The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.
GPS - Global positioning system (GPS) is a navigation system that uses satellite signals to identify the location of an object on Earth. This is the same technology that shows users the route from one location to another while driving.
Geofencing - The use of GPS technology to create a boundary around a fixed location. Geofencing limits the consumer and provider from leaving the consumer's home, as the software will be notified that a home care visit has ended or is flagged for review, withholding payment for services rendered.
HIPAA - The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a U.S. law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers.
Independent living - A worldwide philosophy that looks at society and disability as a movement of people with disabilities working for equal opportunities, self-determination, respect and dignity. The key features of independent living include a disabled person's right to choice, control, flexibility, freedom and equality.
Independent provider - An individual person providing home care or personal care services to a consumer. See also: Provider
Medicaid - A health care program that pays for home care and personal care services for disabled consumers. Medicaid is jointly funded by the federal government and your state government. The federal government sets minimum program requirements. Each state may choose to add more services or provide the services in a different manner, which is why Medicaid programs are different state to state. States cannot provide less services than the federal government tells them.
Provider - An agency or individual person providing home care or personal care services to a consumer.
Telephony - A form of electronic visit verification; use of a telephone to call-in and call-out of shifts. Telephony systems are very different from one another. Some may use biometrics, such as voice verification technology.
What do EVV systems look like?
Electronic Visit Verification (EVV) can take many forms. Some of the most common types of EVV include technology such as telephony visit verification (TVV), mobile apps, fixed visit verification systems (FVV), or website timesheets.
Website timesheets are one of the least restrictive EVV systems. Consumers and providers can log-in to a website where they keep track of time worked, services provided, and their location. This system would require verification from both the provider and consumer, and automatically transmit to payroll services upon validation.
Telephony visit verification offers providers a phone-based time-in/out system. They call a designated phone number from the consumer’s home to confirm their arrival.
Mobile apps are another version of EVV. Consumers and/or providers install an app on their mobile smart device (cell phone or tablet) and can log-in and out using password protection. Some of these apps also use GPS tracking features.
Fixed visit verification (FVV) input devices are provided to a consumer with or without a telephone in their home. They are typically battery operated and very small without features such as geolocation, cameras or microphones. The provider presses a button upon arrival and before departure to capture the time of visit. Typically a 6-digit output, this number correlates to the consumer, location and time. The number can be written down to transfer to a third-party later or punched into a telephone system.
Why are states required to implement EVV?
Congress passed a federal law in December 2016 called the 21st Century Cures Act. Section 12006 of the bill requires every state to implement a form of EVV for all personal care services and home health care services that are paid by Medicaid.
What does the EVV mandate require?
EVV systems must verify (1) the type of service provided, (2) the date the services was provided, (3) the location of the service delivery, (4) the individual providing the service, (5) the individual receiving the service, and (6) the time details, including service start and end times.
When does EVV need to be implemented?
EVV must be implemented by January 2020 for all Medicaid-paid personal care services, and by January 2023 for all home health care services, or the state will lose a portion of their federal Medicaid funds. If your state applied for and received the Good Faith Effort exemption, their personal care services programs must be implemented with EVV use by January 1, 2021.
My state received a Good Faith Effort exemption. Why do we still need to implement EVV in 2020?
The Good Faith Effort (GFE) exemption gives states one additional year to fully implement EVV. If states with GFE exemption do not have every provider using EVV by January 1, 2021, they will lose part of their federal Medicaid dollars. In order to meet the deadline, states must roll out EVV during 2020 to ensure problems are addressed prior to 2021.
Are agencies required to use EVV?
Yes, if the agency provides personal care services or home health services, they must use EVV.
Are consumer-directed personal care programs and waivers required to use EVV?
Yes. All personal care services paid via Medicaid must implement the use of EVV.
What are some problems with EVV?
Some states are going far beyond the federal requirements by designing and/or purchasing EVV technologies that include GPS tracking, biometrics, geofencing, video cameras and audio recording that are out of the control of the consumer. These devices are required to be used in the personal home, tracking movements, activities and conversations, as well as in the community. These components are unnecessary, invasive, and violate the Fourth Amendment rights of consumers, their families, friends and associates, and home care providers. Moreover, there are serious concerns regarding who has access to the collected data and storage security. Some consumers are reporting HIPAA violations, where their EVV device displays on-screen personal information for both themselves and their providers.
Additionally, many EVV systems complicate an already challenging power dynamic for individuals and providers under consumer-direction programs or waivers. Navigating a successful employer-employee relationship poses unique difficulties given that the employee (independent provider) is physically managing tasks for the employer (consumer), yet being paid by a third-party (fiscal management agency). When a third-party takes on more responsibility, such as managing schedules or supervising timesheets as EVV demands, it erodes the employer-employee relationship.
There are few EVV systems in play today that offer accessibility to individuals with severe visual, cognitive or mobility disabilities. Alternatives to preferred EVV systems have been challenging for consumers to receive authorization to use.
Lastly, in states with intrusive EVV devices, consumers report a larger than usual occurrence of providers quitting their long-term positions and leaving the home care industry. Nation-wide there is a severe shortage of home care providers. Coupled with decreasing pay that often falls at minimum wage, providers are choosing to find other careers where they have less responsibility, less scrutiny of their commitment and respect to their job, and better pay and benefits. This is leading to higher rates of institutionalization for disabled people as they are unable to find providers willing to work under these conditions.
What solutions does Stop EVV promote?
Stop EVV knows that electronic visit verification systems can be designed in a way that protects the original intent and integrity of independent living programs and waivers. To do so, we call on Congress to exempt consumer-directed programs and shared living environments, such as family provided care or live-in providers, from federal EVV requirements. We further demand Congress and state officials prohibit the use of invasive components in Electronic Visit Verification systems. We refuse to accept that global positioning systems (GPS) tracking, biometric data collection or geofencing is a necessary part of capturing the location feature in EVV. As an EVV solution, Stop EVV recommends and supports the use of web-based time sheets, where both the consumer and individual provider can input and edit shifts on a weekly basis.