Electronic Visit Verification Market

Goals

To better understand the home care market in the US, specifically:
1. The electronic visit verification market (EVV) mandated under the CURES Act;
2. The market opportunity at a state and national level for a software company specializing in the home care sector;
3. What states are doing to adopt new technologies that will help them comply with the CURES Act;
4. The states with the greatest need for EVV vendors; and
5. Competitors to HHAeXchange, including Axis Care, AXXESS, ClearCare(WellSky), Sandata, Healthstar, and FirstData.

Early Findings

Electronic Visit Verification Market (EVV)

  • The 21st Century Cures Act, which became law in 2016, mandates that each state must "implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider."
  • The EVV system that each state acquired was supposed to be implemented by 1 January 2020. If a state failed to comply they were subject to "incremental FMAP reductions up to 1% unless the state has both made a “good faith effort” to comply and has encountered "unavoidable delays."
  • As at the 1 January 2020 deadline, only a few states had successfully implemented the required technology to comply with the regulations. Most states are selecting/have selected a state-sponsored vendor because those EVV systems operated by a state-sponsored vendor or the state qualify for enhanced FMAP matching funds.
  • States can verify data by a GPS mobile app on the caregiver's phone, interactive voice response, where caregivers call from the client's home, or a dedicated EVV device in the client's home.
  • States could request an additional year to comply to the regulations providing they had made a good faith effort to comply.
  • Samsung partnered with software providers like Tellus EVV and Actsoft "to offer bundled packages that include smartphones, a data plan and an EVV solution that meets all state and federal requirements."

Position of States as at 19 December 2019

  • The following states had selected a state-mandated external vendor: Alabama; Connecticut; Illinois; Kansas; Nevada; New Mexico; Oklahoma; South Carolina; South Dakota (with exceptions); and Texas;
  • The following states were undecided: Alaska; Idaho; Iowa; Kentucky; Maine; Montana; New Jersey; New York; North Dakota; and Wyoming.
  • The following states had selected an open vendor: Arizona; Colorado; Delaware; Florida; Georgia; Hawaii; Indiana; Louisiana; Massachusetts; Michigan; Minnesota; Missouri; Nebraska; New Hampshire; North Carolina; Ohio; Pennsylvania; Rhode Island; Vermont; West Virginia; and Wisconsin.
  • The following states had selected a state-mandated in-house vendor: California; Maryland; Mississippi; and Oregon.
  • Tennessee had gone with MCO choice.
  • Utah, Virginia, and Washington, went with provider choice.
  • Open Source means "providers can use a state-sponsored vendor free of charge or choose another EVV vendor at their own cost."

Best Practice

  • The best practice for implementing a EVV system includes, assessing current systems and providers, evaluating existing state relationships, defining the states requirements, integrating the EVV system with other Medicare state systems, understanding technological capabilities, obtaining stakeholder input, assessing staff capacity, and implementing the selected system.

Summary

  • We could find now discussion on the CARES Act and the EVV market, we have therefore assumed that the legislation referred to is the 21st Century Cures Act, which is of direct relevance to the home care market.
  • In our first hour of research, we have researched the viability of the request, and scoped a plausible research path. Out initial research suggests all of the data required to reach the goal is readily available in the public domain.

Proposed next steps:

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