New EVV Requirements Will Affect Every Medicaid Home Care Agency in New Jersey
Sandata Technologies, the leading provider of electronic visit verification™ (EVV™) software to the home care industry, announced today its chief executive Tom Underwood will present on the federal EVV mandate and its potential effects on New Jersey’s home care agencies.
Underwood’s presentation is part of a panel discussion entitled “Electronic Visit Verification: The Future of EVV for Medicaid Providers,” on Thursday, June 22, as part of the Home Care & Hospice Association of N.J. annual exhibition, in Galloway, N.J.
As background, the December 2016 passage of the 21st Century Cures Act requires EVV to be performed by all providers of home care and home healthcare services when billing through Medicaid. The Act was passed to better combat fraud in these health sectors, and is designed to verify home care services billed are for actual visits made. Although the Cures Act is a federal mandate, state Medicaid departments have been charged with choosing how EVV standards are rolled out in their states, and in overseeing compliance among home care providers. Deadline for state Medicaid departments and home care agencies to implement EVV programs is Jan. 1, 2019.
New Jersey’s Department of Human Services, which includes its Medicaid services division, has not made a decision as to how it will require home care providers to implement EVV systems. So far, states have chosen one of four models:
- Provider choice model, in which home care agencies can choose whatever EVV software solution they’d like, and pay for its use;
- State choice model, in which the state acquires an EVV solution(s) to be used by all agencies
- MCO choice model, in which the state mandates that each MCO choose an EVV solution that is used by their providers, and
- Open platform model, in which agencies can use the software of their choice, with those software packages connected to a state-administered data collection system, which would allow for the monitoring of EVV compliance and billing.
“There’s a good deal of uncertainty in the New Jersey market place right now as the state government considers various implementation options,” said Underwood. “Because the Act just passed in December 2016, many home care providers will use this year’s home care conference as an opportunity to learn more about the Cures Act and its requirements.”
Each of the models has its benefits and disadvantages, according to Sandata. For example, “state choice” requires home care agencies to use software purchased by the state, and the agencies must adapt their operational processes around this new software. This can be very challenging for many agencies. On the other hand, an advantage of the state choice model for the Medicaid division is that it allows greater transparency, better reporting, and produces the best ROI for the state. The “provider choice” model allows home care agencies to choose whichever software they want, which is an advantage for many of the providers, but in this model they are generally responsible for the costs and this model is sometimes referred to as an “unfunded mandate” for the provider community. The MCO choice model is generally the easiest to implement for the Medicaid division, but this model is very burdensome on the provider community as each MCO can choose a different EVV vendor. This has a negative impact on the efficiency of providers since they have to use multiple solutions, depending on the payer.
“We believe the open model offers the best of both worlds to home care agencies and NJ’s Medicaid division,” said Underwood. “Home care providers are offered the flexibility to use whatever EVV solution they want, but all claims are funneled through an aggregator system where standardized business rules are applied to ensure visits are properly verified and ultimately paid, providing comprehensive oversight to the entire program.”
Sandata, which invented EVV technology and has 37 years’ experience providing EVV solutions, worked closely with the sponsors of the Cures Act, the Congressional Budget Office, the National Association of Home Care Providers and the Alzheimer’s Foundation to provide input and expert testimony on EVV. In a Nov. 25, 2016, report, the Congressional Budget Office scored the Cures legislation and forecasted that EVV will save $290 million between 2017-2026.
Prior to the enactment of the EVV mandate, a growing number of home care providers are using EVV to manage and monitor the delivery of care to their patients. For other home care providers, EVV represents an opportunity to upgrade information technology. EVV technology, along with agency management software, allows home care providers an opportunity to create efficiencies in the verification, care management, staffing and billing of services.
“When implemented correctly, EVV solutions – especially when combined with other provider management software – provides a platform for home care agencies to do more than just comply with a federal mandate,” said Underwood. “Information that flows from the point of care provides the foundation for assuring claims and billing are accurate, that treatment delivered is documented, and allows for streamlined communications and for better staffing adjustments.”
According to Underwood, many home care agencies will face an EVV learning curve. “Based on our experience, we expect agencies to evolve in their use of EVV from compliance to cost effectiveness to competitive advantage,” Underwood said. “Compliance is typically the initial goal, but soon agencies realize EVV and additional agency management software can make their operations more cost effective. Soon they realize that the efficiencies they’ve gained through digitizing the process is a competitive advantage, improving patient care and attracting care givers. And with the growing focus on Value Based Payments, we believe the use of EVV will be critical for providers and payers who are “at risk” for the health outcomes of members in the home setting.”
About Sandata Technologies
Sandata Technologies (www.sandata.com), headquartered in Port Washington, N.Y., is a leading U.S. provider of workforce and operational management solutions and services that enable government agencies, Managed Care Organizations, and home care providers to manage and optimize the delivery of home care services. Sandata has 37 years of experience in EVV™ solutions and a wide range of home care software solutions, including Santrax® Agency Management, Santrax® Point of Care, and Santrax® Electronic Visit Verification. Sandata has worked with nine state Medicaid agencies and six national managed care organizations. Its software solutions are implemented in more than 3,500 agencies nationally.