NY Medicaid Electronic Visit Verification Program (EVV)

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Program Information

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. States must require EVV use for all Medicaid-funded PCS by January 1, 2020, and HHCS by January 1, 2023, or demonstrate a "good-faith" effort to implement EVV.

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

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 safeguarding 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

New York State Medicaid is sharing the following information so that individuals and their families can learn more about EVV and its requirements.

New York State Medicaid is sharing the following information so providers and agencies can learn more about EVV requirements.

  • 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

There are multiple EVV designs that can meet the requirements of the 21st Century CURES Act. New York State can select the model that best fits the needs of service recipients, providers and the State. New York State will be engaging stakeholders to discuss EVV designs and approaches and has released an EVV Provider Survey to understand current EVV utilization.

New York State Model Decision

New York State "Choice Model"

Following a series of engagements with a wide variety of stakeholders and carefully considering input from Medicaid beneficiaries, family caregivers, providers, advocates, partner agencies and Electronic Visit Verification (EVV) solution providers, including information gathered from a Request for Information (RFI), New York has 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, preserving the investment that has already been made, avoiding duplicative costs, and eliminating disruption to consumers and caregivers.

To implement the Choice Model, NYSDOH will require that providers of Medicaid-funded personal care services (PCS) select, and put into production use, EVV systems that meet the requirements of the 21st Century Cures Act by January 1, 2021. Providers of Medicaid-funded Home Health Care Services (HHCS) will be required to select and implement such systems by January 1, 2023. In addition, providers will be required to submit EVV data to NYSDOH, which will be aggregated for reporting and audit purposes.

Electronic Visit Verification (EVV) Program Requirements, including considerations for selection an EVV system can be found here.

On April 10, 2020, New York State submitted to the Center for Medicare and Medicaid (CMS) the State's Model Choice for Electronic Visit Verification, which can be found here.

Interface Control Document (ICD)

As discussed on recent Technical Assistance Calls, NYSOH is posting a draft Interface Control Document (ICD) for review and comment. The ICD describes the relationship between the Electronic Medicaid of New York (eMedNY) information system and EVV Submitters and specifies the requirements of both participating systems. This includes the concept of operations, the file structure and protocols that govern the interchange of data, and the communication paths along which the data is expected to flow. The ICD can be found here.

Comments can be sent to EVVHelp@health.ny.gov.

EVV Stakeholder Convening Report

During the three-month period from May 30 to July 18, 2019, NYSDOH held a series of web-based sessions and in-person Listening Sessions throughout the State to receive input from Medicaid beneficiaries, family caregivers, providers, advocates, and other stakeholders on the State´s implementation of EVV for Medicaid-funded personal care and home health care services. A summary of the feedback received at those sessions and responses to a survey of personal care and home care providers was collected in an EVV Stakeholder Convening Report, available here.

EVV Good Faith Effort (GFE) Extension Request

The federal 21st Century Cures Act, which mandates EVV compliance in all states, 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 October 30, 2019, the Department submitted a request for a one-year GFE extension from the Centers for Medicare and Medicaid Services (CMS), which can be found here. The EVV website will be updated in the future to reflect CMS´s determination.

On December 5, 2019, the Department´s EVV Good Faith Effort (GFE) exemption request was approved by CMS, delaying the required implementation date for EVV to January 1, 2021 for Personal Care Services (PCS). The CMS approval letter can be found here.

EVV Request for Information

The State issued a Request for Information (RFI) to solicit information from vendors regarding EVV solutions to assist the State in beginning to identify EVV solutions that address and reflect, to the maximum extent possible, input received from stakeholders and meet the EVV requirements.

The RFI can be found here.

The Department has compiled a summary report of the information it learned from the RFI, available here. The report presents a summary of the feedback received from the EVV Request for Information (RFI) released to the vendor community that, in addition to stakeholder feedback received during the Regional Listening Sessions, was used to help inform the State’s selection of a model for implementing EVV.

EVV Event Calendar

DOH will host a series of technical collaboration calls to assist with questions related to EVV implementation.

Schedule of EVV Technical Assistance Calls
Date Location Time Presentation
4/20/2020 Online Webinar
Register here
2:00 p.m. Presentation
Recording
Transcript
5/5/2020 Online Webinar
Register here
2:00 p.m. Presentation
Recording
Transcript
5/19/2020 Online Webinar
Register here
2:00 p.m. Presentation
Recording
Transcript
6/2/2020 Online Webinar
Register here
2:00 p.m.  
6/16/2020 Online Webinar 2:00 p.m.  
6/30/2020 Online Webinar 2:00 p.m.  
7/14/2020 Online Webinar 2:00 p.m.  
7/28/2020 Online Webinar 2:00 p.m.  
8/11/2020 Online Webinar 2:00 p.m.  
8/25/2020 Online Webinar 2:00 p.m.  
9/1/2020 Online Webinar 2:00 p.m.  
9/15/2020 Online Webinar 2:00 p.m.  
9/29/2020 Online Webinar 2:00 p.m.  
10/13/2020 Online Webinar 2:00 p.m.  
10/27/2020 Online Webinar 2:00 p.m.  
11/10/2020 Online Webinar 2:00 p.m.  
11/24/2020 Online Webinar 2:00 p.m.  
12/1/2020 Online Webinar 2:00 p.m.  
12/15/2020 Online Webinar 2:00 p.m.  
12/29/2020 Online Webinar 2:00 p.m.