Electronic Visit Verification (EVV): FAQs

The following are FAQs the Wisconsin Department of Health Services (DHS) has received from stakeholders through public forums, the EVV email box, and the Wisconsin EVV Advisory Council.

This page will be revised with new information as it becomes available.

Overview

What is EVV?

Electronic visit verification (EVV) is a system that uses technology to verify that authorized services were provided. Workers will be required to send information to an EVV system at the beginning and end of each visit, including:

  • Date of service.
  • Time of service.
  • Location of service.
  • Service type.
  • Individual providing the service.
  • Individual receiving the service.

New! Why implement EVV?

DHS is implementing EVV to be in compliance with the federal 21st Century Cures Act. This is mandatory for Medicaid programs in all states. The Centers for Medicare & Medicaid Services (CMS) will fine state programs if they do not implement EVV.

New! What is the federal 21st Century Cures Act?

Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services and home health services that require an in-home visit by a provider. This applies to personal care services provided under sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k), and Section 1115 and home health services provided under Section 1905(a)(7) of the Social Security Act or a waiver.

On August 19, 2019, CMS granted DHS approval of its EVV good faith effort exemption request.

With this approval, CMS will not apply federal fines against Wisconsin Medicaid funding during calendar year 2020. This approval allows Wisconsin Medicaid to implement the EVV system during calendar year 2020 without the risk of being fined for noncompliance.

New! What programs and services does EVV affect?

EVV affects all personal care and home health services, including services provided through Wisconsin Medicaid and BadgerCare Plus fee-for-service (ForwardHealth card), BadgerCare Plus and SSI HMOs, Family Care, Family Care Partnership, and IRIS (Include, Respect, I Self-Direct).

DHS has determined the procedure codes that will be impacted by EVV.

BadgerCare Plus Fee-For-Service and BadgerCare Plus and SSI HMOs

The impacted procedure code for ForwardHealth (BadgerCare Plus fee-for service and BadgerCare Plus and SSI HMOs) is T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).

Family Care and Family Care Partnership

The impacted procedure codes for Family Care and Family Care Partnership are:

  • T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).
  • T1020 (personal care services, per day)
  • S5125 (attendant care services, per 15 minutes)
  • S5126 (attendant care services, per day)
IRIS

IRIS will be updating procedure codes with the waiver renewal on January 1, 2021. Therefore, beginning with EVV's soft launch, the impacted procedure code for IRIS is T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).

After the IRIS waiver is renewed effective January 1, 2021, the impacted procedure codes for IRIS will also include:

  • S5125 (attendant care services, per 15 minutes)
  • S5126 (attendant care services, per day)

New! When will EVV be implemented?

The federal 21st Century Cures Act initially required states to implement the EVV requirement for personal care services by January 1, 2020 (and home health services by January 1, 2023), to avoid federal funding penalties; however, individual states could apply for a one-year extension to delay any funding penalties until January 1, 2021. States needed to demonstrate a "good faith" effort to CMS to receive the extension. DHS applied for, and received the extension.

DHS will provide further details on the implementation timeline during the upcoming fall public forum.

New! What is a soft launch?

DHS will be rolling EVV in two phases, a "soft launch" and "hard launch." The soft launch is a period in which all provider agencies and caregivers will be required to use EVV, but it will not be integrated into claims processing.

The soft launch will be a time to cooperatively overcome any initial hurdles and help establish processes.

New! What is the hard launch?

DHS will be rolling out EVV in two phases, a "soft launch" and "hard launch." The hard launch is when DHS will require personal care service claims to include required EVV information, or they may be denied.

New! Will workers be assigned a unique ID number for EVV?

Yes. EVV requires a way to identify the individual providing services. Assigning a unique ID protects the workers personally identifiable information within the EVV system. This will be addressed in training.

How can I provide my feedback?

You can contact DHS by emailing the EVV box.

New! How will DHS engage with stakeholders?

DHS has created an EVV stakeholder engagement plan that will be reviewed and updated based on the needs of the project and input from stakeholders. The plan consists of the following:

  • Provider agency workgroup: Began meeting in 2017
  • Provider agency survey: Completed in August 2018
  • Member, participant, worker, and association forums in various statewide locations and online 
  • HMO, MCO, and IRIS administrator meetings: Held as needed throughout planning and implementation
  • Wisconsin EVV Advisory Workgroup: Kickoff held on November 15, 2018, and monthly meetings will be held throughout the life of the project
  • Email box: Established for all feedback
  • Email list: Created so stakeholders can receive EVV updates

Has DHS researched how other states implemented EVV?

Yes. DHS has contacted numerous states to discuss how they have implemented EVV. DHS is also participating in meetings where states discuss their EVV implementation designs and lessons learned.

Member and participant questions

New! Can Wisconsin choose not to implement EVV?

No. Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services and home health services that require an in-home visit by a provider. States that do not implement EVV will experience financial penalties from CMS.

New! How does Sandata protect information?

Sandata upholds rigorous standards for Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and data protections and uses strategies such as encryption to ensure protected health information is secure. Sandata is certified by the Health Information Trust Alliance (HITRUST), conducts regular mandatory training and sends frequent communications to all Sandata employees regarding best data security practices.

New! Will providers be financially impacted by the implementation of EVV?

The 21st Century Cures Act requires the implementation of EVV to be "minimally burdensome." Minimally burdensome does not mean it will have no impact, but DHS will work to minimize impact when possible.

Agencies should expect to incur some costs for the training and setup of the state-provided system. DHS will collaborate with stakeholders to ensure these changes have the least amount of financial impact on members, participants, workers, and providers while still meeting federal requirements.

New! What technologies will be available to submit visit verification information through Sandata?

  • Sandata Mobile Connect (MC or MVV): A mobile application to collect visit information
  • Sandata Telephonic Visit Verification (TVV): Uses automatic number identification (ANI) technology to validate phone calls from the member's or participant's identified phone number(s) and collects visit information.
  • Sandata Fixed Visit Verification (FVV): Offers an alternative to verify visits with a small, in-home device when no other visit collection methods are possible or available.
  • Sandata EVV Aggregator: Allows provider agencies to continue to use a third-party EVV system as long as it meets technical requirements

New! Will EVV require internet access?

An onsite internet connection is not needed to check in and out on the mobile app. The encrypted visit information can be uploaded at a later time when an internet connection is available.

No internet connection is required for TVV or FVV.

New! Where can I see a Sandata system demonstration?

The April 2019 EVV forum provided a general Sandata system demonstration (beginning at the 30-minute mark). The demonstration is not specific to Wisconsin's EVV solution.

New! Who is responsible for training agency workers to use EVV?

DHS will implement a robust training plan. The details of the training plan, including who will train workers, are still being decided. A final training plan will be communicated to agencies.

New! Does the EVV GPS monitor a worker at all times, including before and after work?

The technology used to verify the worker's location only records locations at the start and end of the service. It does not record their location at any other time.

New! Will scheduling be used to know if there are any missed visits?

No. The DHS-provided Sandata EVV system does not include a scheduling module. Provider agencies may elect to purchase additional features, such as scheduling, from Sandata or alternative EVV vendors.

New! Will natural or unpaid supports (unpaid help and care that someone received from their friends, family, or community) be required to use EVV?

No. EVV is for services paid for with state Medicaid dollars. EVV is not applicable to unpaid support.

New! How can I submit EVV questions?

You can contact DHS by emailing dhsevv@dhs.wisconsin.gov.

Provider agency, worker and association questions

New! Who is the EVV vendor in Wisconsin?

On November 19, 2018, DHS announced that our current Medicaid Management Information System (MMIS) fiscal agent, DXC Technology, contracted with Sandata Technologies as the EVV vendor. DHS made this decision to optimize integration with the current MMIS.

New! How does Sandata protect information?

Sandata upholds rigorous standards for Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and data protections and uses strategies such as encryption to ensure protected health information is secure. Sandata is certified by the Health Information Trust Alliance (HITRUST), conducts regular mandatory training, and sends frequent communications to all Sandata employees regarding best data security practices.

New! Will providers be required to use Sandata's EVV technology?

No. DHS will use Sandata's aggregator technology to implement EVV, which allows providers who already have an EVV system to continue to use it if it meets EVV and DHS aggregator use requirements. The aggregator merges the data from the existing system into the Sandata system.

New! What third party systems does the Sandata aggregator work with?

The Sandata aggregator will work with any system that meets the technical requirements. Technical specifications are forthcoming. 

Will Sandata Technologies be allowed to charge impacted providers, HMOs, MCOs, or IRIS program administrators for use of the EVV system?

No.

Will impacted providers need to purchase an EVV system?

No.

Do agencies need to pay the state to use the EVV system being provided?

No. Agencies will not pay for use of the state-provided EVV system.

New! Will providers be financially impacted by the implementation of EVV?

The 21st Century Cures Act requires the implementation of EVV to be “minimally burdensome.” Minimally burdensome does not mean it will have no impact, but DHS will work to minimize impact when possible.

Agencies should expect to incur some costs for the training and setup of the state-provided system. DHS will collaborate with stakeholders to ensure these changes have the least amount of financial impact on members, participants, workers, and providers while still meeting federal requirements.

New! What technologies will be available to submit visit verification information through Sandata?

  • Sandata Mobile Connect (MC or MVV)—a mobile application to collect visit information
  • Sandata Telephonic Visit Verification (TVV)—uses automatic number identification (ANI) technology to validate phone calls from the member’s or participant's identified phone number(s) and collects visit information
  • Sandata Fixed Visit Verification (FVV)—offers an alternative to verify visits with a small, in-home device when no other visit collection methods are possible or available
  • Sandata EVV Aggregator—allows providers to continue to use a third-party EVV system as long as it meets technical requirements

New! Who will provide the technology?

DHS will provide access to the Sandata EVV system free of charge. The hardware for submitting data to this system must be provided by the agency, worker, or member/participant. This may include a cell phone, tablet, or landline. More specific information will be provided in the training phase of the project.

New! Will there be any charges for FVV devices (for example, installation, data, or service)?

While the FVV devices will be paid for by DHS, the phone to call in the visit must be provided by the agency, worker, or member/participant. The FVV device is considered the option of last resort. More specific information related to FVV will be provided in the training phase of the project.

New! Does Sandata have a mobile app for EVV?

Yes. DHS will work with Sandata to configure its existing mobile application for Wisconsin’s needs. The app will be available for Android and iOS (Apple) devices.

New! How much data and battery life is used on a cell phone for each visit?

The app takes relatively little memory on a cell phone (comparable to a calendar app, about 12 MB) and uses minimal data for each check in/out pairing (comparable to one minute of Facebook time, about 0.1-0.3 MB).

New! Will EVV require internet access?

An on-site internet connection is not needed to check in and out on the mobile app. The encrypted visit information can be uploaded at a later time when an internet connection is available.

No internet connection is required for the TVV or EVV solutions.

New! Can a worker use a cell phone that is not a smart phone to call in using telephone (TVV)?

For TVV, a landline must be used; it confirms location the same way the 911 system does. If TVV is used from a cell phone, the call/visit will be recorded but the end report will note the location was not confirmed in the usual way.

New! Where can I see a Sandata system demonstration?

The April 2019 EVV forum provides a general Sandata system demonstration (beginning at the 30-minute mark). The demonstration is not specific to Wisconsin's EVV solution.

Who is responsible for training agency workers to use EVV?

DHS will implement a robust training plan. The details of the training plan, including who will train workers, are still being decided. A final training plan will be communicated to agencies.

Does the EVV GPS monitor a worker at all times, including before and after work?

The technology used to verify the worker’s location only records locations at the start and end of the service. It does not record their location at any other time.

New! Will scheduling be used to know if there are any missed visits?

No, the DHS-provided Sandata EVV system does not include a scheduling module. Provider agencies may elect to purchase additional features such as this from Sandata or alternative EVV vendors.

New! Will EVV affect long-term care facilities who are working with individuals enrolled in Family Care and whose care is funded by an MCO?

No, per CMS, personal care services received in a hospital, nursing facility, ICF/IID or IMD, do not require use of EVV.

New! Will RNs be using the verification during supervisory visits?

No, the nurse will not need to use EVV during their supervisory visit.

Will natural or unpaid supports (unpaid help and care that someone receives from their friends, family, or community) be required to use EVV?

No. EVV is for services paid for with state Medicaid dollars. EVV is not applicable to unpaid support.

New! How can I submit EVV questions?

You can contact DHS by emailing the EVV box.

Program administrator (HMO, MCO, fiscal employer agents) questions

How can HMOs, MCOs, and fiscal employer agents submit questions?

You can contact DHS by emailing the EVV box.

Working to answer in the near future

DHS received the following questions, and they will be answered once decisions are finalized.

Overview Questions

Will EVV be implemented statewide simultaneously?

Member and Participant Questions

Will the member or participant need to use EVV to verify that services were received?

Provider Agency, Worker, and Association Questions

  • When will the mobile app be available?
  • Where does the information from the EVV system go?
  • Will EVV change how claims are submitted or processed?
  • Will DHS deny payment for claims that do not have corresponding EVV data?
  • Will the implementation of EVV require any regulation changes?
  • What services will require EVV?
  • What will the process be for clocking in and out for EVV?
  • What billing codes are affected by EVV?
  • Will the DHS EVV system incorporate scheduling, billing, or other modules?
Last Revised: November 7, 2019