Electronic Visit Verification Phase II
Electronic Visit Verification (EVV) is a telephone and computer-based solution that electronically verifies in-home service visits occur. EVV solutions must verify: Type of service performed; Individual receiving the service; Date of the service; Location of service delivery; Individual providing the services; and Time the service begins and ends.
Pursuant to Subsection (l) of Section 1903 of the Social Security Act (SSA) (42 U.S.C. 1396b), all states must implement EVV for Medicaid-funded personal care services (PCS) by January 2020 and home health care services (HHCS) by January 2023. In accordance with federal provisions, the State submitted a Good Faith Effort Exemption (GFE) request on October 2, 2019 to the Centers for Medicare & Medicaid Services (CMS) to extend the EVV implementation date for PCS to January 2021. On October 22, 2019, CMS approved the State's GFE request for PCS, and will not apply Federal Medical Assistance Percentage (FMAP) reductions in calendar year 2020. California's GFE approval letter from CMS is available on the EVV CMS GFE Webpage.
EVV will impact all PCS and HHCS provided under the Medi-Cal State Plan and various Medicaid Home and Community-Based Service waiver programs. These services are provided in California through programs managed by the Department of Health Care Services (DHCS), the California Department of Social Services (CDSS), the Department of Developmental Services (DDS), the California Department of Public Health (CDPH), and the California Department of Aging (CDA).
California is implementing EVV in two phases:
Phase I: This Phase is for the In-Home Supportive Services (IHSS) program and Waiver Personal Care Services program, focused on EVV implementation for programs that currently use the Case Management Payrolling & Information Systems (CMIPS II) and Electronic Time Sheet System (ETS). Further information about Phase I is available on the CDSS EVV website.
Phase II: This Phase is focused on identifying a solution(s) to implement EVV for non-CMIPS and agency PCS, and self-directed and agency HHCS. This includes programs at DHCS, DDS, CDPH, CDSS, and CDA as listed below:
- DDS 1915(c) Waiver, Self-Directed and Agency Model
- DDS 1915(i) State Plan, Self-Directed and Agency Model
- DDS 1915(c) Waiver Self-Determination Program, Self-Directed, and Agency Model
- DHCS Waiver Personal Care Services, Agency Model
- DHCS Home and Community-Based Alternative 1915(c) Waiver
- DHCS Home Health Care Services
- CDA Multipurpose Senior Services Program for 1915(c) and 1115 Waiver
- CDPH 1915(c) AIDS Medi-Cal Waiver
Note: There are two models for the provision of PCS and HHCS, the Self Directed/Individual Provider Model and the Agency Provider Model.
The Self Directed Model, also known as the Individual Provider Model, supports the provision of PCS by an individual provider. This model gives the recipient, or their authorized representative, the autonomy to hire or fire a provider of their choosing as well as to instruct them on how to facilitate their PCS needs.
The Agency Provider Model supports the facilitation of PCS and/or HHCS by an authorized agency who is responsible for hiring, firing, and training personnel to facilitate services on behalf of an eligible Medi-Cal beneficiary. Agency Providers are employed by commercial agencies who manage their work, process payroll, and issue their paychecks. These agencies can either have contracts with counties or enroll through DHCS as a Medi-Cal provider.
Please direct your comments, questions, or suggestions regarding the EVV Phase II, or to be added to the EVV Phase II stakeholder process interested parties e-mail list, to EVV@dhcs.ca.gov.