Electronic Visit Verification and In-Home Caregivers

Wednesday, December 16, 2020

In compliance with Section 12006 of the 21St Century Cures Act (the Cures Act), language was added to Section 1903(l) of the Social Security Act that requires the use of an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) and Home Health Services (HHS) that require an in-home visit by a provider for states participating in the Medicaid program. The Cures Act requires that NCDHHS begin using an EVV system for PCS by Jan. 1, 2021.

Programs subject to the EVV requirement include State Plan PCS [In-Home], Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Disabled Adults (CAP/DA), self-directed personal attendant care services, Innovations Waiver, TBI Waiver and the 1115 Managed Care Demonstration Waiver. 

The Cures Act excludes live-in paid caregivers from verifying in-home personal care visits. To ensure those waiver participants are not subject to the requirements under EVV, the CAP/C and CAP/DA plans of care (POC) live-in status section must be updated to indicate the waiver participant who only receives personal care services (in-home aide, pediatric nurse aide, personal assistance, respite and congregate services) from a paid live-in caregiver.

A paid live-in caregiver lives in the waiver participant’s home and is authorized to render personal care-type services approved in the waiver. This person may be employed through an in-home aide agency, a home health agency or consumer direction. The in-home aide agency, home health agency and financial management agency must report to the case manager when a waiver participant-only assigned caregiver is a paid live-in caregiver.

A waiver participant who has multiple paid workers/caregivers and at least one of those workers is not a paid live-in caregiver, is NOT excluded from the EVV requirements and will require in-home visit verification. The live-in status section on the POC should not be selected as a paid live-in caregiver. 

The e-CAP systems for both CAP/C and CAP/DA were modified to allow CAP case managers to identify live-in paid caregivers for currently approved services that are listed below in the chart. There will be a one-time entry routine for CAP case managers to document the personal care-type services the waiver participant is approved to receive by a paid live-in caregiver. The results of this one-time entry will be used by e-CAP to automatically update the current POCs to account for waiver participants who are excluded from EVV. 

In addition, the e-CAP POC service entry functionality will be modified to allow CAP case managers to enter or update the live-in status of the paid caregivers as part of the regular POC service entry or update process. This new functionality is expected to available between Dec. 14, 2020 and Dec. 20, 2020, to support the EVV process once implemented in January 2021.

The following service codes are included in the EVV requirements that will implement on Jan. 1, 2021:

CAPDA

S5125

CAPDA

S5125

UN

CAPDA

S5150

CAPC

S5125

CAPC

S5150

CAPC

T1019

CAPC

T1004

CAPC

S9122

TF

CAPC

S9122

TG

CAPC

T2027

CAPC

T2027

TF

CAPCD

S5135

CAPCD

S5135

UN

CAPCD

S5125

UN

CAPCD

S5125

CAPCD

S5150

EVV Background Information

EVV uses technology to record the times, dates and specific services that are provided in the home by a non-live-in, paid caregiver. Each time a non-live-in, paid caregiver visits the waiver participant’s home to help with activities of daily living (ADLs), an electronic device (mobile visit verification, telephone or fixed visit verification) must verify at least the following things:

  • The date the service was provided 
  • The location the service was provided 
  • The time the service begins and ends
  • That the type of approved service was provided 
  • The correct person received the service
  • The hired caregiver was the one who provided the service 

Frequently Asked Questions

Q: What would be the live-in status of a waiver participant with multiple workers and one of the workers is a paid live-in caregiver?
A: The waiver participant would not meet the paid live-in caregiver status exemption.

Q: Are paid live-in caregivers through the consumer direction program excluded from the EVV requirements?
A: If the paid caregiver lives in the home of the waiver participant using consumer direction services, and no other paid caregivers are providing one of the personal care-type services including the waivers, the caregivers are excluded from the EVV requirements.  

Q: Beginning Jan. 1, 2021, will the POC for the continued need review (CNR), initials or revision require documentation of the paid, live-in caregiver?
A: Documentation will not be required; however, the POC will have a live-in status section for the case manager to select that appropriate option of the caregiver's status.

Q: What evidence is required to prove a waiver participant only has a paid, live-in caregiver and is excluded from the EVV requirement? Does the documentation need to be uploaded in e-CAP?
A: Written confirmation from the in-home agency, or the financial management of the hiring of the live-in caregiver and that the paid, live-in caregiver is the only worker rendering the personal care services through the CAP waivers will serve as sufficient evidence of exclusion. Additional documents will not need to be updated in e-CAP. The POC should indicate the provider agency. The in-home or home health agency is responsible to comply with the EVV requirements and program integrity.

Q: What role does the CAP case manager have with the provider agency in managing EVV?
A: The case manager’s responsibility is to develop a service plan that includes a POC that accurately authorizes the personal care-type service subject to EVV through the selected in-home aide or home health agency. The in-home aide or home health agency is ultimately responsible to comply with the EVV requirements and follow state and federal guidelines in verifying in-home aide visits.

Resources:
CMS – EVV
NC Medicaid - EVV

CONTACT
Medicaid.EVV@dhhs.nc.gov