Overview of the 21 st Century CURES Act The CURES Act is designed to - PowerPoint PPT Presentation

Section 12006 of the 21 st Century CURES Act: Electronic Visit Verification Systems Shannon Spence Personal Care Services Unit Manager February 26, 2018

Overview of the 21 st Century CURES Act • The CURES Act is designed to improve the quality of care provided to individuals through further research, enhance quality control, and strengthen mental health parity. • Section 12006 of the CURES Act requires states to implement an electronic visit verification (EVV) system for Personal Care Services (PCS) by Jan. 1, 2019 & for Home Health Services (HHCS) by Jan. 1, 2023. SOURCE: CMS (2017) Section 12006 of the 21 st Century CURES Act Session 1: Requirements, Implementation, Considerations, and State Survey Results [PowerPoint Slides]. Retrieved from https://www.medicaid.gov/medicaid/hcbs/downloads/training/evv-presentation-part-1.pdf. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 2

What is EVV? • EVV is a method used to verify visit activity for services delivered as a part of home and community based service (HCBS) programs. • EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services, receive them. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 3

EVV Requirements • EVV Systems MUST ST verify: − Date of Service − Location ion of service delivery − Individ ividual ual pro rovid viding ing service − Typ ype of service performed − Individ ividual ual receiving ving service − Time service begins and ends ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 4

Services to be included in EVV • Phase 1 — Target Jan. 1, 2019 − 1905(a)(24) State Plan Personal Care Services benefit − 1915(c) HCBS Waivers − 1915(i) HCBS State Plan Option − 1915(j) Self-directed Personal Attendant Care Services − 1915(k) Community First Choice State Plan Option − 1115 Demonstration Waiver • Phase 2 — Target Jan. 1, 2023 − 1905(a)(7) State Plan Home Health Services − Home Health Services authorized under a waiver of the plan CMS (2017): Section 12006 of the 21 st Century CURES Act Session 1: Requirements, Implementation, Considerations, and State Survey Results [PowerPoint slides]. Retrieved from https://www.medicaid.gov/medicaid/hcbs/downloads/training/evv-presentation-part-1.pdf. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 5

Potential Benefits of EVV • Improve program efficiencies by: − Eliminating the need for paper documents to verify services. − Facilitating the flexibility for appointments and services. • Strengthen quality assurance for PCS and HHCS by: − Improving health and welfare of individuals by validating delivery of services. CMS (2017): Section 12006 of the 21 st Century CURES Act Session 1: Requirements, Implementation, Considerations, and State Survey Results [PowerPoint slides]. Retrieved from https://www.medicaid.gov/medicaid/hcbs/downloads/training/evv-presentation-part-1.pdf. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 6

Potential Benefits of EVV • Aims to reduce potential Fraud, Waste, and Abuse by: − Validating that services are billed appropriately according to the individual’s personalized care plan by ensuring appropriate payment is based on actual service delivery. − Being a part of the pre-payment validation methods that allows individuals and families to verify services rendered. CMS (2017): Section 12006 of the 21 st Century CURES Act Session 1: Requirements, Implementation, Considerations, and State Survey Results [PowerPoint slides]. Retrieved from https://www.medicaid.gov/medicaid/hcbs/downloads/training/evv-presentation-part-1.pdf. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 7

EVV’s Impact on Beneficiaries • No significant disruption of services to beneficiaries. • Beneficiaries will be able to keep current providers and caregivers provided they comply with the EVV requirement. • An EVV system does NOT change the services provided, the provider selection, constrain the individual’s choice of caregiver, or impede the way care is delivered. • EVV will be a valuable tool in managing the accuracy and reporting of all services. ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 8

For Further Information For questions contact: MedicaidEVV@dhhs.nc.gov ELECTRONIC VISIT VERIFICATION| FEBRUARY 2018 9

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