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Colorado EVV program for in-home Medicaid services is ready to go

A 2016 federal law, the 21st Century Cures Act, mandates that each state as part of its administration of Medicaid-funded services create an electronic visit verification system, known as EVV. EVV check-ins will prove that in-home Medicaid services by health care providers really happened.

Specifically, the Cures Act will require EVV for personal care services, or PCS, and home health care services, or HHCS. The electronic check-in must provide six pieces of information:

  • Type of service
  • Date of service
  • Location of service
  • Person providing service
  • Person receiving service
  • Time services begins and ends

EVV is an attempt to decrease fraudulent Medicaid billing in home-based services for elderly people and those with disabilities. The federal mandate has specific requirements, but states may expand their EVV programs to monitor more kinds of services than the federal minimums. For example, Colorado is going beyond federal requirements in some areas.

According to Disability Scoop, states are not required to use EVV if the provider lives with the patient, only when a caregiver comes into the patient’s home to deliver services. When a service includes both time at home and in the community, EVV check-ins only need to happen for the home-based portion.

In most circumstances concerning delivery or set-up of medical equipment or supplies, EVV will not be required.

Critics are concerned about EVV technology not protecting private patient information. For example, while the law does not require use of GPS, most states plan to use GPS technology as part of their EVV systems, which could, in essence, place an electronic monitor on the patient’s whereabouts when they are with a service provider.

Colorado implementation

Medicaid is a federal-state program, called Health First Colorado in our state. If states do not kick off their EVV programs on time, the federal government will withhold funding incrementally until compliance.

EVV for PCS is supposed to be in place by Jan. 1, 2020, and for HHCS by Jan. 1, 2023. States may ask for one-year extensions under some circumstances, but Colorado’s EVV website says that it will be ready to go in 2020 for both kinds of services, including those that go further than the federal law requires.

Many of our clients have family members with disabilities or who are seniors, and some of these loved ones may receive Medicaid services in their family homes or their own homes, so EVV monitoring may become part of those visits soon.

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