Electronic Visit Verification Helps States Comply with 21st Century Cures Act

January 23, 2019 Bob Morris

State government health department executives must strive to fully embrace electronic recordkeeping this year to comply with key provisions of the 21st Century Cures Act and avoid regulatory scrutiny down the road.  

Signed into law in late 2016, 21st Century Cures received bipartisan support to modernize the National Institutes of Health and the Food and Drug Administration, combat the nation’s opioid epidemic, speed medical innovation and the approval of lifesaving disease therapies.

Key provisions of the law stipulate that each state’s Medicaid program must provide Electronic Visit Verification (EVV) to better track and monitor in-home private care services (PCS) by January 1, 2020, and home healthcare services (HHCS) by January 1, 2022.

Failure to comply with the above deadlines will force a reduction in federal Medicaid reimbursements. According to the Centers for Medicare and Medicaid Services (CMS), each state’s Federal Medical Assistance Percentage (FMAP) will be reduced by .25% every year for four years, capping at a total 1% reimbursement deduction after four years of non-compliance.

State healthcare administrators recognize that our nation’s aging population and rising healthcare costs are two challenges not likely to subside anytime soon. CMS has predicted that federal, state and local governments are likely to bear more of the healthcare support burden, sponsoring 47% of national health expenditures by 2026, up from 45% in 2016.

For states to achieve full compliance and ‘do more with less,’ they must strive to apply digital technologies where they can, improve mission-critical processes and constituent interactions, and streamline manual, paper-driven processes.

CMS guidance for implementing EVV

When implementing EVV for Medicaid personal care and home healthcare service programs, CMS offered the following best practices:

  1. Assess EVV systems, if any, currently used by providers.
  2. Evaluate the state’s existing vendor relationships.
  3. Define EVV requirements.
  4. Integrate EVV systems with other Medicaid state systems and data.
  5. Understand technological capabilities.
  6. Solicit stakeholder input.
  7. Assess state staff capacity to develop and/or support an EVV system, including user training/education.
  8. Roll out EVV in phases and/or pilots.

A 2019 EVV resolution

As Congress welcomes new leadership into the House of Representatives, the national healthcare debate is likely to re-ignite. Some congressional leaders intend to focus on how best to ensure the provision of healthcare services to as many people as possible, while others will focus on finding solutions to control rising costs.

One area of potential cost savings is likely to come from in-home care services. According to the Bureau of Labor Statistics, between 2016 and 2026, seven of the top 30 fastest growing occupations will be in healthcare, including three of the top five, personal care aides, registered nurses, and home health aides.

At the same time, state administrators will also need help fighting fraud and abuse in subsidized home health and personal care services.  In addition to federal law enforcement assistance, state administrations need better digital tools to help ensure accurate tracking of in-home patient care visits.

This is where Conduent is well-positioned to help state government leaders ensure accuracy and reduce fraud in subsidized health services. Conduent Electronic Visit Verification (EVV) solutions use mobile, biometric and/or Interactive Voice Response (IVR) technologies to ensure accurate tracking of in-home patient care visits. Our solutions help state agencies streamline formerly paper-based, manual processes, reducing fraud and ensuring compliance with the 21st Century Cures Act. It’s our goal to make subsidized home healthcare services easier and more accessible for all parties, from patients, to providers and state government administrators.

Ultimately, no matter how quickly the nation’s healthcare services change or grow, one thing is clear – state government leaders must embrace new tools and services to help them better manage the cost of care, while keeping up with demand for those services, now and in the years ahead.

About the Author

Bob is SME/Government Industry Specialist at Conduent Legal and Compliance Solutions.

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