State Electronic Visit Verification Program Models

What providers need to know about state EVV models

On December 13, 2016 the 21st Century Cures Act (CURES) came into law. Section 12006 of the legislation directs states to require the use
of Electronic Visit Verification (EVV) for Medicaid-provided personal care services and home health services.

The CURES Act leaves states to decide their own implementation strategies and there are so far four models:

• Provider Choice

With this EVV model, the state gives providers the freedom to chose and fund an EVV solution that best fits their needs and budget. The vendor must comply with Medicaid rules for electronic documentation.

• MCO Choice

With MCO choice, the state gives the responsibility of funding, selecting and implementing an EVV solution to the Managed Care Organizations (MCOs). Where there are multiple MCOs, providers could potentially be required to use multiple EVV solutions.

• State Choice

The state Medicaid program contracts with a single EVV vendor and mandates that all Providers use that vendor’s EVV system.

• Open Vendor Model

With the Open Vendor Model, the state provides an EVV solution but also allows providers and MCOs to keep their existing EVV systems -for those who already had integrated Electronic Visit Verification into their operations-. The state also gives providers the freedom to chose any existing EVV solution as long as it complies with Medicaid rules.