Proposed House Bill Would Mandate Electronic Visit Verification System for Personal Care Services under Medicaid
September 16, 2015 02:06 PM
Representative Brett Guthrie (R-KY-2) has introduced legislation that would require each state to use an electronic visit verification (EVV) system for personal care services under Medicaid. The bill would penalize any state that does not require the use of an electronic visit verification system for personal care services. For any such state, the legislation would reduce the Federal medical assistance percentage by 0.25 percentage points for calendar quarters in 2018 and 2019; by 0.5 percentage points for calendar quarters in 2020; by 0.75 percentage points for calendar quarters in 2021; and by 1 percentage point for calendar quarters in 2022 and each year thereafter. At this point, Representative Guthrie is the only listed supporter of the legislation.
The bill was among several proposals discussed by the House Energy & Commerce Subcommittee on Health on Friday, September 11, during a hearing titled, “Strengthening Medicaid Program Integrity and Closing Loopholes.” Subcommittee Chairman Joe Pitts (R-PA-16) said, “It is my hope that through the policies we discuss today, and through future actions by this committee, we can work together on a bipartisan basis to boost Medicaid program integrity, while making the program more sustainable, accountable, and transparent.” Regarding H.R. 2446 specifically, Pitts said: “This common-sense proposal will ensure taxpayers only pay for the services delivered to Medicaid beneficiaries.”
Representative Guthrie, in discussing his legislation (H.R. 2446) at the hearing, said: “Medicaid personal care services are becoming increasingly more important as the need for them continues to grow. However, there is also growing concern about the high levels of improper payments in this area. My bill will help address these concerns by requiring states to adopt an EVV system to verify the date, time and site of the visit as well as the provider of the services. This is critical to ensure that beneficiaries receive the services they need. Many states already operate EVV systems and they have seen a decrease in improper payments and significant cost-savings for the states.”
Two witnesses spoke in support of the legislation. Nico Gomez, Chief Executive Officer of the Oklahoma Health Care Authority, stated in his testimony: “Through the first three years of the EVV system, Oklahoma had over a 5 to 1 return on its investment through resulting cost savings.” Additionally, John Hagg, Director of Medicaid Audits for the Office of Inspector General at the U.S. Department of Health and Human Services stated that there are “significant problems” with personal care services fraud. He stated that EVV “may help” prevent instances of fraud and high error rates with personal care services: “When you have cases of lack of documentation, I would think EVV would help clear that up. You’re either providing the service at the location, or you’re not. The same thing with beneficiaries who are in institutions at the same time we’re receiving a bill. Same thing for when we have a time sheet of an attendant that says they were at a different location, yet we have a bill for somebody else. I think EVV would help, or may help, prevent those types of issues.”
At the same time, a number of Representatives expressed reservations or concerns about the proposal. One of the concerns highlighted by Representative Jan Schakowsky (D-IL-9) was the fact that there has not been a cost-benefit analysis of EVV. This concern was reiterated by witness Trish Riley, Commissioner of the Medicaid and CHIP Payment and Access Commission. The legislation “raises questions about the cost of that,” Riley said. “It’s again the cost-benefit trade-off. I think there are nine or ten states that currently have those systems. They have said that they are succeeding in getting savings from those activities, but we are not aware of any evaluations that have been underway or completed that would tell us really what the cost-benefit analysis of that verification activity is.”
Representative Schakowsky also expressed concern about the fact that the legislation penalizes state FMAP funds, while it does not provide startup funds for states to adopt EVV. “Personal care services may be an area that is vulnerable to fraud, and we must make sure that beneficiaries are receiving the services they need at the right time and the right way. However, I have concerns about a penalty on the states’ FMAP in an environment where Medicaid programs are really struggling right now administratively.” Schakowsky raised the question of whether the penalties coupled with the lack of incentives would force states to reduce spending on Medicaid services in order to implement EVV. Riley confirmed the lack of startup funds, and added that another problem is that there is a lower federal match rate for front-end activities such as EVV, compared to the higher match rate “to go get them when there is a mistake or fraud has occurred.”
In response to the issues of state cost to adopt EVV, Guthrie claimed that the legislation “would not cost the states money.” He justified this based on the fact that the bill requires states to use an EVV system, but does require states build their own systems.
Representative Frank Pallone (D-NJ-6) also expressed concerns with the legislation “as drafted.” He stated he looks forward to working with the committee on improvements, as it is an issue that should be addressed.
The National Association for Home Care & Hospice (NAHC) is evaluating the legislation with the design of developing improvements. There are some concerns with the present version of the bill as it may affect provider costs and multi-state organizations. In addition, NAHC believes that the bill should support uniform EVV system specifications that can be met by EVV vendors. Representative Guthrie has expressed a willingness to work with the home care provider community in refining the bill.
To review the proposed legislation, click here. For more information about the hearing, including witness testimony, click here.