Electronic Visit Verification Certification
Section 1903(l) of the Social Security Act, as added by section 12006 of the Cures Act (Pub. L. No. 114-255) and further amended by Public Law No. 115-222, stipulates that states will be subject to a reduction in Federal Medical Assistance Percentages (FMAP) if they do not implement Electronic Visit Verification (EVV) for personal care services by January 1, 2020, and for home healthcare services by January 1, 2023, absent a one-year extension based on the Centers for Medicare & Medicaid Services (CMS) approval of a state’s Good Faith Effort application. While the Cures Act does not require states to have their EVV systems or data aggregation solutions certified for federal financial participation (FFP) to avoid FMAP reduction, it does allow states to apply for FFP for EVV systems. If a state applies for FFP under the Advance Planning Document process, its EVV solution will need to be certified.
CMS has developed a streamlined, outcomes-based approach to EVV certification. This approach focuses on achieving business outcomes embodied in the Cures Act and is intended to reduce the certification burden on states. In doing so, CMS aims to ensure that systems receiving FFP are meeting the business needs of states and of CMS. EVV certification is structured around the following elements:
- Outcome statements. These describe the desired results once the system is implemented. CMS-provided outcomes are based on the Cures Act.
- Evaluation criteria and required evidence. These correspond to outcome statements and are used by a state and CMS to evaluate the system’s functionality and its compliance with laws, regulations, and industry good practices.
- Key performance indicators (KPIs). These metrics support the outcome statements and are used to track the performance of the system over time.
Compared to the process found in the Medicaid Enterprise Certification Toolkit (MECT), this process for EVV certification is streamlined in the following ways:
- Reduced Certification Evaluation Criteria. The number of certification evaluation criteria is reduced from 146 to 11.
- Streamlined Reviews. States undergo an Operational Readiness Review before the system goes live. At least six months later, a Certification Review is conducted. Project Initiation Milestone Reviews are eliminated.
- Introduced Quarterly KPI Reporting. The state reports on KPIs at least once after the Operational Readiness Review and then quarterly after certification. Quarterly reporting is required for as long as a state continues to receive enhanced funding for operations and maintenance.
- Reduced Artifacts List. Except for the certification request letter and system acceptance letter, the state does not need to prepare artifacts listed in MECT Appendix B, nor does it need to prepare a Project Partnership Understanding.
EVV Certification Version 1.0
CMS released EVV Certification Version 1.0:
- 00 EVV Certification 1.0 EVV Release Notes
- 01 EVV Certification 1.0 EVV Guidance
- 02 EVV Certification 1.0 EVV Evaluation Criteria and KPIs
- 03 EVV Certification 1.0 EVV Intake Form