Medicaid officials are offering up more details about a new requirement that care providers electronically check in when assisting people with disabilities, but advocates say the guidance doesn’t go far enough.

With a bulletin released this month, the Centers for Medicare and Medicaid Services is further clarifying how the new electronic visit verification, or EVV, mandate applies.

The federal agency said that electronic check-in is not necessary in cases where the person needing assistance lives with the caregiver providing the service, though states could choose to require EVV in these circumstances.

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EVV is also not relevant to situations where a home health service offers “delivery, set-up, and/or instruction on the use of medical supplies, equipment or appliances,” according to the bulletin from Calder Lynch, acting deputy administrator and director of the Center for Medicaid and CHIP Services.

Meanwhile, when visits include services provided in the home and in the community, electronic check-in is only required for the portion of services that happens at home, the guidance clarifies. States do have discretion, however, to seek more information in order to “control fraud, waste and abuse.”

Esme Grewal, vice president of government relations at the American Network of Community Options and Resource, or ANCOR, said her group is happy to see that EVV won’t apply to shared living, family caregiving, host homes and similar situations. She also welcomed the distinction between “home” and “community.”

However, she noted that the guidance is catching some states off guard. Grewal said California was planning a pilot using web-based timesheets where the provider and service recipient would both enter the location and time worked as a means of fulfilling EVV obligations. But the guidance specifically indicates that this approach would not fulfill the EVV mandate.

That’s one of many problems — including significant privacy concerns — that remain with the rollout of EVV, Grewal said.

“We are still seeing high error rates, onerous additional work to get the program in place, and we are even seeing systems taking on more than just tracking the six data elements which is causing a lot of privacy and coordination concerns,” she said.

The EVV mandate originated in the 21st Century Cures Act, which was passed by Congress in late 2016, as a means to weed out Medicaid fraud. The law specifies that six pieces of information be electronically verified for any personal care or home health visit — the type of service performed, the date, the location, who’s providing the service, who’s receiving the service as well as the beginning and end time.

Currently, states have until January to implement EVV. However, they can apply for a one-year good faith extension so that they will have until January 2021.

In the interim, advocates are pushing lawmakers to address privacy concerns.

“The problem is that we know that states are far along in this process and while CMS has clarified that GPS is not required, the majority of state systems under contract use it,” said Nicole Jorwic, senior director of public policy at The Arc. “This is very troubling to individuals and their families and we will continue to pursue legislative options to ensure that the desire to eliminate fraud, which we support, don’t also infringe on the civil rights of people with disabilities and the workers who support them.”

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