Electronic Visit Verification

Electronic Visit Verification (EVV) is a federal requirement from the 21st Century Cures Act, passed by Congress in 2016, and mandated to be in place by January 1, 2021. EVV is required for all Medicaid funded in-home personal care services, respite care services, and home health care services as a verification that care services were provided.

Section 12006(a) of the 21st Century Cures Act

Who Uses EVV?

Any care worker providing personal care and/or respite care services funded by Medicaid payments for a client who lives at home (not in an institutional, residential or hospital care setting) and receives payments for these in-home care services must use Electronic Visit Verification.

• This includes the employees of both Home Care Agencies and the Consumer Directed Employer (CDE), who is the legal employer of all Individual Providers (IP) in the state of Washington as of 6/1/2022. The CDE in Washington is Consumer Direct Care Network Washington (CDWA) .
• Individual Providers, employed by the CDE, who Live WITH their client are not required to use EVV.
  • This exception does not apply to contracted Home Care Agency employees and caregiving staff. All Home Care Agency caregiving employees must use EVV for shifts worked.
• If you do NOT live with your client, you must use EVV. The required data elements must be captured at the time of service provision, and included with claims submissions sent by the employing agency, whether it is the CDE or another Home Care Agency. For more information about the EVV exception and requirements, read on.

What is Required?

Claims for personal care services submitted by Medicaid providers must include specific elements to be captured electronically, for compliance with Electronic Visit Verification requirements. EVV systems must verify:

• Type of service performed;
• Individual receiving the service;
• Date of the service;
• Location of the service;
• Individual providing the service;
• Time the service begins and ends. 

Flexibility in System Design

States have operational control over implementation, and Washington has selected a model called the “Provider Choice Model,” which means that providers select their own EVV systems. Washington will not mandate which system(s) is used, and will not recommend one solution over another. Home Care Agency providers may select the solution that works best for your agency’s needs, as long as the EVV element submission requirements are met. Individual Providers employed by Consumer Direct Care Network of Washington use the CDWA system.

Consumer Direct Care Network of Washington (CDWA)

Individual Providers employed by Washington’s Consumer Directed Employer, CDWA, should visit the Consumer Direct Care Network Washington’s website for information on how to create a user account, sign up for training, and download the CareAttend app. 

Exception to EVV Requirement

• EVV requirements do not apply to Individual Providers who live WITH your Client.
• Providers who live together with your client are not required to submit claims or timesheets with EVV elements.
• As part of the hiring process with Consumer Direct Care Network Washington, you will complete an attestation about living with your client.
• Visit the Consumer Direct Care Network Washington’s website for instructions on how to track and submit shifts worked for payment.

Individual Providers who do NOT live with your client will need to use the Electronic Visit Verification app available through the Consumer Directed Employer. For more information about downloading the app and signing up for training visit the Consumer Direct Care Network Washington’s website.

Home Care Agencies

Program information and resources can be found in the following Management Bulletin. 

Home Care Agencies can find more resources on the EVV Resources page.

ProviderOne

ProviderOne is Washington’s data aggregator. ProviderOne receives claims submissions from Home Care Agencies and CDWA, which include all required EVV data elements according to the file layout resources shared in the Resources section below.

Home Health Care Services

Home Health (Acute Care) service agencies who bill ProviderOne Home Health (Acute Care Services) Billing Guide (2022-07-01) for eligible services and care should contact the Health Care Authority Home Health (Acute Care) Program at HCAEVVHomeHealth@hca.wa.gov and/or visit the HCA EVV Home Health website, for details and information about the EVV Implementation for Home Health Care Services.

Resources

• File layout & Claim submission –Health Care Authority ProviderOne Social Services Resources
• General questions about Washington's implementation of EVV requirements can be sent to EVVQuestions@dshs.wa.gov
• For additional information about the federal requirement Click Here   
• If you would like to provide suggestions or have questions about federal EVV requirements, you may contact the Centers for Medicare and Medicaid Services (CMS) directly through the EVV mailbox.