What You Need to Know About
Electronic Visit Verification
April 12, 2017
Darby Anderson serves as Executive Vice President &
Chief Development Officer, Addus HomeCare Corporation.
Darby is in his twentieth year operating and developing
business for Addus, today in excess of $400M in annual
revenue. He has led or otherwise been involved in over 30
transactions including an initial public offering.
Darby has also been appointed or elected to board and
advisory committee positions in multiple states through
state administrations or trade associations, including
currently serving as Vice Chairman of the Medicaid
Partnership for Home Based Care.
Addus HomeCare
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Photot
• Why the 21st Century Cures Act matters for home care
• Electronic Visit Verification (EVV) requirements
• Multi-state provider compliance challenges
• Significance of, and preference for, an EVV “Open”
standard
• How to influence an “Open” standard
• EVV options and pros and cons of each
• Why going beyond simple proof of visit can do more for
your agency
• Addendum includes links to additional sites
Agenda
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• Addus is a provider of comprehensive personal care services and
other activities of daily living, provided in the home.
• At 12/31/2016, Addus provided personal care services to over
33,000 consumers through 111 locations across 24 states.
• Addus has utilized EVV since 2010 and currently has EVV deployed
with 70% of our caregivers across 13 states including (AZ, CA, GA,
IL, MI, MO, NC, NM, NY, PA, SC, TN & WA).
• We have developed a blended solution utilizing both GPS and IVR
technology that best fits the caregiver schedule and environment,
including urban and rural markets.
• Technology captures time in/out, caregiver mileage & travel time,
care plan task performance and change in condition reporting.
ELECTRONIC VISIT VERIFICATION (EVV) EXPERIENCE
Addus HomeCare
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The 21st Century Cures Act is broad-based legislation that
affects the health care industry.
Within its 900+ pages, it touches many topics, including:
• Funding the fight against the opioid epidemic
• Supporting Vice President Joe Biden’s cancer moonshot
• Providing resources to expand precision medicine
• Requiring electronic visit verification (EVV)
• Reforms related to mental health
• Investing in brain research
THE ACT WAS SIGNED INTO LAW ON DECEMBER 13, 2016
What is the 21st Century Cures Act?
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• The bill requires each state to institute EVV for Medicaid programs by January 1, 2019, or they will face reduced federal match.
• EVV can improve accountability and combat fraud by electronically verifying that a caregiver is physically present for a visit.
• Expands information captured efficiently in claims/billing submissions.
• For states moving to MLTSS, provides greater opportunity for enhanced care coordination and data sharing.
STATES WILL REQUIRE PROVIDERS TO COMPLY BY JANUARY 1, 2019
Why Does EVV Matter to States?
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The requirement for the use of an electronic visit verification system under paragraph (1), a State shall consult with agencies and entities that provide personal care services, home health care services, or both under the State plan (or under a waiver of the plan) to ensure that such system
• Is minimally burdensome;
• Takes into account existing best practices and electronic visit verification systems in use in the State; and
• Is conducted in accordance with the requirements of HIPAA privacy and security law
• Consider a stakeholder process that includes input from beneficiaries, family caregivers, individuals who furnish personal care services or home health care services, and other stakeholders, as determined by the State in accordance with guidance from the Secretary; and
• Ensure that individuals who furnish personal care services, home health care services, or both under the State plan (or under a waiver of the plan) are provided the opportunity for training on the use of such system.
• Shall not apply in the case of a State that, as of the date of the enactment of this subsection, requires the use of any system for the electronic verification of visits conducted as part of both personal care services and home health care services, so long as the State continues to require the use of such system with respect to the electronic verification of such visits.
STATES SHALL CONSULT WITH AGENCIES
Requirements for EVV
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With respect to any amount expended for personal care
services or home health care services requiring an in-home
visit by a provider that are provided under a State plan
under this title (or under a waiver of the plan) and furnished
in a calendar quarter beginning on or after January 1, 2019
(or, in the case of home health care services, on or after
January 1, 2023), unless a State requires the use of an
electronic visit verification system for such services
furnished in such quarter under the plan or such waiver, the
Federal medical assistance percentage shall be reduced.
FOR PERSONAL CARE AND HOME HEALTH UNDER MEDICAID
Section 12006. EVV System Required
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The bill requires that the following data, electronically
verified, be submitted with every claim:
• The type of service performed
• The individual receiving the service
• The date of the service
• The location of the service delivery
• The individual providing the service
• The time the service begins and ends
What Data Will Need to Be Submitted?
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An “open” standard means that providers have the freedom
to choose how to verify and submit the data.
Alternatively, a “closed” standard would mean that the state
would choose which method, or even which vendor, you
would have to use.
If I want to call you on the phone, it doesn’t matter which
device or telephone company you use. That’s an “open”
standard. A “closed” standard would require us both to use
the same carrier and, potentially, the same model phone.
AN “OPEN” STANDARD LETS YOU CHOOSE WHAT’S BEST FOR YOU
What is an “Open” EVV Standard?
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An “open” standard gives you flexibility. It:
• Makes it possible for you choose the technology that you
want, to standardize the workflow and processes across
your business, and to reduce training needs.
• Eliminates the possibility of you going backwards in
terms of information and productivity if the state
mandates an inferior method.
• Reduces your risk of being “stuck” with outdated
technology as the market changes.
YOU CAN CHOOSE THE EVV OPTION(S) THAT BEST MEETS YOUR NEEDS
Why is an “Open” Standard a Good Thing?
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Providers should take two kinds of action now:
1. Band together with other providers and lobby your state
for an “open” EVV standard.
2. Investigate the different types of EVV and determine
which is best for your agency.
LOBBY YOUR STATE AND INVESTIGATE EVV OPTIONS
What Should Providers Do Now?
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EVV options range from simple proof-of-visit to the ability to collect
additional valuable data. But, the EVV decision isn’t stand-alone… you
adopt EVV in a broader context.
For example, EVV as part of a complete care delivery management
solution can also provide operational efficiencies, enable improved care
quality, and deliver better information to your management team.
The main EVV options are:
• Telephony/IVR (via a landline phone)
• A device that is placed in the home
• Mobile apps
IT’S IMPORTANT TO INVESTIGATE EACH & TO THINK BEYOND EVV
What Are the Main Options for EVV?
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Pros
• Minimal training... everyone knows how to use a phone• The low-cost option
Cons
• How will you cover clients with no landlines?• 61% of adults over 35 do not have a landline
• People with lower incomes are even less likely to have one
• Risk of fraud: Patients/clients can dial in for caregivers if pass codes are shared without additional safeguards
• Lacks a way to get information to caregivers, limited point-of-care “documentation”, doesn’t cover activities other than visits
• Using client’s phone
ALSO KNOWN AS INTERACTIVE VOICE RESPONSE (IVR)
What Are the Pros & Cons of…
Telephony?
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Pros
• One device can be used by many caregivers
• As with paper, the record remains in the home
• May be used for communication with patient/client
Cons
• Need to place and maintain the device in home
• Risk of device not working (device itself or Wi-Fi), or of it being misplaced, lost, or stolen
• Similar risk of shared password fraud as telephony
• All full and part-time users must be trained on the device
• Risk of contamination from handling by many people
• Direct Care Team data collection is limited to in-home activity, e.g., doesn’t cover mileage, caregiver activities other than visits, etc.
INTERESTING, BUT HOW PRACTICAL, REALLY?
What Are the Pros & Cons of….
In-Home Devices?
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Pros
• GPS time- and date-stamping on a device the caregiver brings to the visit
• Native mobile apps work in and out of cellular coverage
• Secure two-way communication with caregivers at any time: client info, schedules, care plans, notifications, messages, etc.
• Point-of-care documentation, tracking all activities, accurately calculating mileage, etc.
• Affordable solution for all types of caregivers
• May be part of a Care Delivery Management solution
Cons
• If not a native app, there may be connectivity and security issues
• Training required (more and more people are familiar with mobile)
• Requires a data plan or wifi
THERE ARE DIFFERENCES WHEN VENDORS SAY “MOBILE”
What Are the Pros & Cons of…
Mobile Apps
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What Does Your Agency Need to Succeed?
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“Care Delivery Management”
“Basic EVV”
• Business Management
• Direct Care Team Management &
Optimization
• Day-to-Day Operations Management
• Tools & Workflow for In-Home Care
• GPS & Real-Time Location Services
• Designed for All Types of Caregivers
• True Mobile App
INC
RE
AS
ING
V
AL
UE
Complete Care Delivery Management Solution
CARE TEAM PORTAL
SERVICES & SUPPORT
MOBILE APPS• EVV via GPS• Document care delivery• Complete assessments• Communicate securely• Track mileage accurately• And more
IVRElectronically verify visits via land lines
Improve collaboration and care by giving the extended care team visibility into the care record
OPERATIONS TEAM PORTALDo real-time care coordination and risk management, field force management,and care delivery optimization
HEALTHLINKTwo-way integration with EMRs for patient information, schedules, care plans, and visit results
Achieve ongoing success with help from home care and mobile experts
IMPROVE CARE, COMMUNICATION AND COMPLIANCE WHILE REDUCING COST
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Connects the Field & the OfficeNATIVE MOBILE APPS ENABLE EVV & DOCUMENTATION IN AND OUT OF CELLULAR COVERAGE
CLIENT INFORMATION
UP-TO-DATE SCHEDULES
CARE &/OR SERVICE PLANS
FORMS & ASSESSMENTS
CARE TEAM INFORMATION
ON-SCREEN NOTIFICATIONS & REAL-TIME CONFIGURABLE ALERTS
SECURE MESSAGES & BROADCAST MESSAGES
GPS-BASEDEVV
REAL-TIME ALERTS(OPERATIONAL & CLINICAL)
GPS-BASED TIME & MILEAGE
P-O-C DOCUMENTATION
REAL-TIME LOCATION INFO
SECURE MESSAGES & PHOTOS
CLIENT SIGNATURES
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• Receive EVV, and real-time operational and clinical alerts from the POC
• Manage by exception and streamline paper – “clean” visits flow through automatically
• Drill into, report on, and analyze care delivery performance to improve compliance & productivity
• Respond to audits
• Perform IT tasks
Efficient CoordinationOPS TEAM PORTAL PROVIDES VISIBILITY & BUSINESS VALUE
Operations Team Portal is the key to
efficient care delivery. Care Coordinators
use it to monitor, actively manage, and
optimize care and service delivery.
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Coordinate Care Across the Entire Team
CARE TEAM PORTAL PROVIDES REAL-TIME CLINICAL AND CARE INFORMATION
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• Give health care team
members access to
client demographic,
clinical, and visit
information in one
secure, central location
• Increase customer
satisfaction with
permission based
access extended to
patients and their
families
Care Team Portal is essential to seamless care
coordination. Care coordinators, professionals, and
with permission, families, can view alerts, vitals,
assessments, trends, and services delivered.
View information from the point-of-care across all disciplines
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Home and community care organizations, and payers,
improve health care and service delivery with
CellTrak’s Care Delivery Management solution
CellTrak At-a-GlanceTHE INDUSTRY LEADER IN CARE DELIVERY MANAGEMENT
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• 21st Century Cures Act Bill
• Directory of State Associations
• State Medicaid Directors
• CellTrak Information
INVESTIGATE ~ LOBBY ~ CHOOSE THE BEST EVV OPTION
Want More Information?
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For more information
www.celltrak.com
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Darby [email protected]
Lynn [email protected]