What is EVV?
Electronic Visit Verification (EVV) is an electronic method to verify that personal care providers clock-in to their work site when they deliver assistance and services to disabled and older Americans in a private home care setting.
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), biometric recognition (fingerprint or voice verification), 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.
Biometric recognition devices are a dedicated piece of hardware given to the consumer. It uses fingerprint scans, voice recognition, and/or face recognition software to clock-in/out. These devices typically use GPS tracking software, and take photos, video or audio recordings when a third-party request it to do so.
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 2019 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.
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 the problems with EVV?
Some states are going far beyond the federal requirements by designing and/or purchasing EVV technologies that include GPS tracking, 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. Consumer-direction is a personal care service program whereby the disabled individual receiving services is the direct employer. They have the right and responsibility to hire, schedule, train, supervise and, if necessary, fire their own independent providers. Navigating a successful employer-employee relationship poses unique difficulties given that the employee (provider) is physically managing tasks for the employer (consumer), yet being paid by a third-party (Medicaid vendor). When a third-party takes on more responsibility for essential items to the provider, such as managing schedules or supervising timesheets as EVV does, it can erode 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 this 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.
What alternatives does Stop EVV promote?
Stop EVV is a national grassroots campaign led by individuals with disabilities and personal care service providers. We propose the following:
(1) Pass a congressional bill amending the 21st Century Cures Act to exempt consumer-directed programs and family-provided care from EVV requirements, maintaining the intent and integrity of these programs and waivers;
(2) Prohibit the use of invasive EVV components, including GPS tracking, camera use and audio recording within a consumer’s private home;
(3) Recommend the use of website-based timesheets with dual authentication by both the consumer and the provider at the close of the pay period, like most government agencies use for their employees. A website timesheet can be designed to include entry for location, type of service provided, and start and end times. The consumer will be able to authenticate the hours and services provided using their own login and password. Each provider will also have their own, separate and unique login and password to authenticate timesheets. Once both parties have authenticated the same information, these web-based timesheets can be directly, electronically submitted to a third-party payroll for processing.