On Jan. 1, 2021, NC Medicaid began using an Electronic Visit Verification (EVV) system for the Community Alternatives Programs for Children and Disabled Adults (CAP/C and CAP/DA) to comply with Section 12006 of the 21st Century Cures Act. A Medicaid beneficiary participating in a 1915(c) Home- and Community-Based Services waiver who receives personal care-type services is required to comply with the mandates of the EVV requirements, including confirmation of the following:
- The date the in-home aide or pediatric nurse aide service was provided
- The location the in-home aide or pediatric nurse aide was provided
- The time the in-home aide or pediatric nurse aide service begins and ends
- The approved in-home aide or pediatric nurse aide service was actually provided
- The person who was hired to provide the in-home aide or pediatric nurse aide service
Because the CAP waiver is a comprehensive, wraparound program intended to support chronically ill Medicaid beneficiaries so they can live and integrate into their community similar to non-disabled individuals, flexibility is allowed for how the EVV mandates are reported for specific types of enrolled waiver participants. These types of participants are:
- Waiver participants who have a paid live-in caregiver
- Waiver participants who are directing their care using consumer-directed services
For participants who have a paid live-in caregiver, the flexibility granted is the exemption from reporting the EVV requirements listed above only for the paid live-in caregiver. A paid live-in caregiver is defined as a person who lives in the same household as the waiver participant and is hired and paid by an in-home aide or home health agency or through the consumer direction program to assist with activities of daily living (ADL) and instrumental activities of daily living (IADL). An in-home aide, home health agency or financial management entity does not have to report visits of a paid live-in caregiver in their EVV solution or the State’s aggregator. The in-home aide, home health agency and financial management entity must document in their records the confirmation the paid live-in caregiver shares the same address as the waiver participant.
This documentation consists of an attestation statement of the paid live-in status to be included with the employment agreement and two supporting pieces of evidence, one of which must be a driver’s license or another valid photo ID and the other a utility-type or credit card statement/bill, a residential lease agreement, school enrollment forms if enrolled in school or graduated from school within the past three months, or an acceptable piece of evidence approved by NC Medicaid at the request of the provider. These two supporting pieces of evidence must list the address of the paid live-in caregiver to be the same address as the waiver participant which must be confirmed initially upon hire and annually during the CAP enrollment renewal period. These documents should be filed in your agency’s personnel file or waiver participant’s case file.
Because consumer direction promotes flexibility in how services are planned and rendered, for a waiver participant who is directing their care using consumer-directed services, the only EVV requirements that must be reported are the approved in-home aide or pediatric nurse aide service listed on the point of contact and the person who has been hired to provide the in-home aide or pediatric nurse aide service. Because of the flexibility to use services based on a given day’s specific needs, the reporting of the date and times the service begins and ends and the location the service was provided can be reported differently from what is listed in the service authorization.
Under the consumer direction program, the waiver participant or their designee is the employer of record, which is essentially the provider agency for reporting of the EVV mandates.
It is understandable that transitioning to this new requirement of reporting visits electronically may be a challenge for some. To ensure workers hired through the consumer direction program are paid for providing in-home aide or pediatric nurse aide services each pay period, manual updates to visits that are confirmed from a completed and signed paper timesheet can be made by the employer of record or the financial management entity in the EVV solution before submitting the visits to the State's aggregator. If a training need is identified by the financial manager for the employer of record or the hired worker, training can be arranged on how to use electronic devices such as a mobile device, a computer or a fixed visit verification device to record visits. This training would be arranged through the waiver service to include training, education and consultative services. The financial manager will assess the training need and report to NC Medicaid.
NCTracks Contact Center: 800-688-6696