On November 2, 2020, the Wisconsin Department of Health Services (DHS) will implement the soft launch phase of electronic visit verification (EVV) for Medicaid-covered personal care and supportive home care services: procedure codes T1019, T1020, S5125 and S5126.*
DHS is committed to working with stakeholders to integrate EVV while maintaining services and ensuring needed care is delivered. DHS will not deny claims or disregard submitted encounters without EVV data during the soft launch.
This soft launch phase will integrate EVV into the visit and claims process and prepare for the hard launch phase of EVV. The date for hard launch of the EVV program in Wisconsin has not been set.
*Beginning January 1, 2021, EVV will be required in the IRIS program for procedure codes S5125 and S5126.
What is EVV?
EVV is an electronic system that uses technologies to verify that authorized services were provided. Workers will be required to send information at the beginning and end of each visit to an EVV system, including:
- Who receives the service
- Who provides the service
- What service is provided
- Where service is provided
- Date of service
- Time in and out
The following ForwardHealth Updates contain additional information about EVV policy and training:
- Policy: ForwardHealth Update 2020-31 "Implementation of Electronic Visit Verification for Personal Care and Supportive Home Care Services"
- Training: ForwardHealth Update 2020-32 "Electronic Visit Verification Training for Personal Care Services and Supportive Home Care Services"
Wisconsin's EVV informational video
We invite you to watch and share our informational video about EVV. Sam Self-Determined and Pat Provider will walk you through the basics of EVV and answer some common questions.
The Centers for Medicare & Medicaid Services (CMS) issued states additional guidance on EVV requirements. CMS provided states the flexibility to decide if live-in workers and services rendered in the community are subject to EVV requirements.
DHS policy decisions
- DHS is not requiring EVV for live-in workers.
- DHS will require EVV for services regardless of where the services are provided, whether in the community, in the home, or both.
- Managed care organizations (MCOs), health maintenance organizations (HMOs), and provider agencies may independently decide, based on business needs, if their live-in workers are required to use EVV.
- IRIS Fiscal Employer Agents (FEAs) cannot require participant-hired live-in workers to use EVV.
Definition of a live-in worker
For the purposes of Wisconsin EVV, a live-in worker is a worker who permanently resides in the same residence as the Medicaid member receiving services. Workers who do not meet this definition are not considered live-in workers. Live-in worker status must be established between each member and worker. When a live-in worker provides services to more than one member with whom they permanently reside, live-in worker status must be validated for each member.
Live-in worker examples:
- Workers who live with the Medicaid member receiving services for only a short period of time, such as two weeks, are not considered live-in workers.
- Workers who work 24-hour shifts, but are not residing with the Medicaid member "permanently," are not considered live-in workers.
Public forum materials
The July 29, 2020, public forum materials are available.
This requirement affects all personal care and home health services, including services provided through:
- Medicaid and BadgerCare Plus fee-for-service (ForwardHealth card)
- BadgerCare Plus and Medicaid SSI HMOs
- Family Care and Family Care Partnership
- IRIS (Include, Respect, I Self-Direct)
DHS will work to:
- Maintain services provided, including community integration.
- Support provider selection.
- Keep an individual’s choice of a worker.
- Ensure needed care is delivered.
- Ensure data is secure and compliant with the Health Insurance Portability and Accountability Act (HIPAA).
Please download and share our:
- EVV handout, which provides a broad overview of EVV and includes our continued commitment to quality services.
- Member flyer, which helps inform members and participants of the EVV program and provides additional resources to learn more.
- Your Key to EVV newsletter, which provides the latest EVV information, including quick tips and answers to common questions.
- EVV Live-in Worker Identification form and instructions, which provides additional live-in worker information as it pertains to EVV.
Provider agencies, members, participants, workers, and program payers can contact Wisconsin EVV Customer Care by phone at 833-931-2035 or by email for help with technical and program-related questions. Wisconsin EVV Customer Care hours are Monday–Friday, 7 a.m.–6 p.m. CT.
Input from our stakeholders is essential to the successful implementation of EVV. Questions and comments can be emailed to the EVV box or mailed to:
Division of Medicaid Services
Attention: Electronic Visit Verification
PO Box 309
Madison, WI 53707-0309
Pursuant to Section 12006(a) of the 21st Century Cures Act, which mandates that states implement EVV for all Medicaid personal care services that require an in-home visit by a provider