NY Medicaid Electronic Visit Verification Program (EVV)

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Program Information

21st Century Cures Act Requirements

The 21st Century Cures Act, is a federal law, passed by Congress in December 2016, that in part requires all state Medicaid programs to implement an EVV system for personal care services (PCS) and home health care services (HHCS). All states must implement an EVV system to avoid a reduction in federal Medicaid funding. The Cures Act includes a provision that allows for the delay of implementation for up to one year if a state has encountered unavoidable delays, as demonstrated in a good faith effort (GFE). On December 5, 2019, the New York State Department of Health´s EVV GFE exemption request was approved by the Centers for Medicare and Medicaid Services (CMS).

As such, the New York State Department of Health (NYSDOH) required providers of Medicaid-funded PCS to select and implement EVV systems that meet the requirements of the 21st Century Cures Act by January 1, 2021. Providers of Medicaid-funded HHCS will be required to select and implement compliant EVV systems by January 1, 2023.

For more information on the federal law and requirements for EVV, visit:
Medicaid.gov

What is EVV?

EVV is a system that may include multiple point-of-care verification technologies, such as telephonic, mobile, and web-based verification inputs. The system electronically verifies the occurrence of home- or community-based service visits, identifying the time that service provision begins and ends to ensure accurate claims disbursement and helping to ensure that beneficiaries who are authorized to receive services get the expected care. EVV is used to:

  • Verify visits on a real-time basis, including date, location, type of service, individual(s) providing and receiving services, and duration of service(s)
  • Validate hours of work for home health employees
  • Eliminate billing data entry mistakes
  • Reduce costs related to paper billing and payroll
  • Help combat fraud, waste, and abuse

Choice Model

After a series of engagements with a wide variety of stakeholders, and after carefully considering input from Medicaid beneficiaries, family caregivers, providers, advocates, partner agencies, and EVV solution providers, including information gathered from a Request for Information (RFI), New York elected to proceed with the Choice Model for implementing EVV. New York selected the Choice Model for the following reasons: (1) it best ensures that consumers will have EVV options from which to consider when selecting a provider; (2) it gives providers of service the flexibility to select an option that best meets their business needs and the needs of the consumers they serve; and (3) it recognizes that many providers serving New York´s Medicaid consumers have already implemented EVV systems that meet the requirements of the Cures Act, thereby preserving the investment that has already been made, avoiding duplicative costs, and eliminating disruption to consumers and caregivers.

Providers are required to submit EVV data to NYSDOH. The data will be aggregated for reporting and audit purposes.

Impacted Programs

The following list provides the programs affected by the implementation of EVV for PCS and HHCS.

  • 1905(a)(24) State Plan Personal Care Benefit
    • Consumer Directed Personal Assistance (CDPA)
    • Personal Care Assistance (PCAI & II)
  • 1915(c) Home and Community Based Services waivers
    • Childrens´ Waiver
    • Nursing Home Transition and Diversion (NHTD)
    • Traumatic Brain Injury (TBI)
    • Office for People with Developmental Disabilities (OPWDD) comprehensive
  • 1115 Demonstration
    • CDPA
    • PCAI & II

Below is the list of applicable PCS billing codes for Fee-for-Service (FFS) and Managed Care (MC) Medicaid that are subject to EVV requirements. If you service any of the following billing codes, you are required to participate in EVV and send EVV data to the New York State data aggregator.