Are You Ready for EVV? · Worst and Most Complex Scenario • Each MLTC chooses a different EVV Vendor • State selects an Aggregator solution • Agency chooses to use the solution

Increasing the Capacity to CareImproving the Process of Home Care

Sandata Technologies, LLC

© Copyright 2019 Sandata Technologies, LLC. All rights reserved

Steve [email protected](516) 484-4400 ext. 4175Sandata Technologies, LLCwww.sandata.com

Are You Ready for EVV?

• Sandata’s EVV Experience

• EVV Mandate / 21st Century Cures Act

• EVV Defined

• NY EVV Status

– RFI & Summary of Stakeholder Sessions

• Review of EVV Models Deployed– Pros/Cons, And Things To Be Aware Of

• Gotcha’s

• Best Practices to Ensure Readiness

Confidential and Proprietarywww.sandata.com

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Agenda

EVV Experience

SOLUTIONS

INCREASING THE CAPACITY TO CARE BY…

Optimizing the value of every in-home encounter

Maximizing the efficiency of homecare Providers

Enabling collaboration between Payers and Providers

EXPERIENCE

Focused on homecare technology for 40 years

Experience with 15 state Medicaid Agencies and 8 MCOs

Only EVV solution with CMS certification

Only vendor with experience with all 4 state EVV models

Proven Statewide Open EVV solution

SCALE

250 employees dedicated to the Home Care market

150M+ Transactions/year

90+ integration points with 3rd party systems

3K+ clients in US, managing 1.3M patients

Daily reach of 400K+ homes3

Electronic Visit Verification System Required for Personal Care Services and Home Health Care Services Under Medicaid

• States that do not comply by the mandated dates will face an escalating penalty:

– Personal Care Services: January 1, 2020– Home Health Services: January 1, 2023

• The EVV system must capture six data elements:

– Location and Type of service;– Individuals Providing and Receiving service;– Date and Time the service Begins and Ends.

• States must:

– Implement a process to seek input from beneficiaries and caregivers

– Consult with Agencies and ensure the program:

- Is minimally burdensome, HIPAA compliant, takes into account existing EVV systems

• Good Faith Efforts (GFE):

– States can submit requests for GFE between July-Nov 2019

– CMS may grant a one year extension

EVV Mandate/21st Century Cures Act Overview

EVV qualifies for Enhanced Federal Match

90% Implementation Fees75% Operational Fees

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EVV & Evolving Reimbursement Models

EVV Will Enable Providers to Operate in the VBP Market

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In the Home

Capture Data

Case Managers

Share it

Interventions

React to it

Value creation

Measure it

To Get Paid

Report on it

Value-Based Payment Models are Increasing

– Definition is evolving, but data is the secret sauce

– To participate, providers must…

EVV at POCEVV at POC

The REAL Value of EVV

ProviderPayerPayer

• Authorization

• Member

Provider

• Staff

• Schedules

• Tasks

• Confirm visit

• 6 Data Elements

EVV Defined – Today and Tomorrow

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Current EVV Solution Required by Cures

• Authorization

• Member

• Diagnosis codes

• Acuity

Alert Engine

• Staff

• Schedules

• Tasks

• Quality metrics

• Interventions

• Escalations

• Reporting

• Confirm visit

• 6 Data Elements

• Tasks Performed

Health Status Answers

Medication Adherence

Social Determinants

Diagnosis Specific

The Value of EVV Data?

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Are you taking your

medications?

Are you eating regularly?

Are you hydrating?

Have you fallen since

our last visit?

Have you noticed weight

changes?

If This Were Your Mom…Would You Want to Know?

Cures Act Requires The Collection of 6 Data

Elements

What Is The Incremental Cost To Collect 1 More Data

Element?

• RFI issued October 17th

– Responses due Nov 7th

– Onsite demonstrations expected Nov 18th – 22nd

• Programs Impacted in New York State– Personal Care Services Program (PCSP)

– Consumer Directed Personal Assistance Program (CDPAP)

– Certified Home Health Aide (CHHA)

– Community Habilitation Program and Skills Acquisition Maintenance and Enhancement (SAME)


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NY EVV Status

• Meets the requirements of the Cures Act

• Adheres to the self-directed principles of CDPAP

• Is accessible to individuals with disabilities

• Is available in multiple languages

• Maximizes the use of cost-effective, industry related, and application-ready ‘off the shelf commercial’ technologies where feasible

• Provides flexible rules-based technology to adapt to evolving state and federal standards, regs, and processes

• Comprehensive and adaptable reporting capabilities

• Provide functionality to support provider and consumer centric business models

• Comply with HIPAA, federal, and state regulations and statutes

• Capable of interfacing with existing New York state systems


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Desired Environment

• Eight In-person and two webinar sessions May – July 2019

• Survey sent to providers – 146 responses received (20% response rate)– Only 50% of respondents were aware of EVV mandate under the

Cures Act– 32% indicated they have EVV in place today

• Themes– EVV solutions must be flexible– Minimize costs for providers– Address the unique needs of consumer directed population– Ensure privacy and security with respect to data collection

• Four Major Milestones1. Information gathering (complete)2. Formulating EVV implementation options, developing a strategy to execute 3. Implementation of the selected option4. Evaluation and monitoring of the implementation


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NY State Listening Sessions - Summary


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Review of Models Deployed (Pros/Cons)

1. Provider Choice Model

2. MLTC/MCO Choice Model

3. State Choice Model

4. Open Vendor Model

Two Models are Optimal to

Maximize the Effectiveness of Medicaid Programs

EVV Model Summary

Compliance, Cost, Business Burden, Ease of Implementation, Outcomes

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• State defines requirements for EVV

• Providers select an EVV solution

• State deploys Aggregator to collect EVV data

Provider Choice

• State provides EVV option for Providers who opt to use it

• Providers Choose: Pays for EVV or their own

• State deploys Aggregator to collect EVV data

Open

Vendor

Two Variations of the Open Model Should Be Avoided

To Ensure Provider Efficiency and Productivity

BUT…. Open Isn’t Necessarily Open

Call to Action – Make Your Voice Heard to Prevent These Variations

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• State declares an Open Model

• State allows MLTCs to select an EVV solution

• State allows MLTCs to mandate the use of a single EVV solution

Open with Multi-Payers

• State declares an Open Model

• State selects an EVV vendor that Aggregates the EVV data from multiple vendors

• State-selected solution requires Providers submit claims through their system

Open with Closed Billing

EVV Models in Multi-Payer Environment

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Caregivers

• Will need to know which Payer covers each member they serve

• Use multiple applications to record visit information

• Manage logins/passwords for multiple vendors

Scheduling Staff

• Will need to schedule in multiple applications

• Manage staff availability across multiple applications

• Add/Delete staff in multiple applications

Billing Staff

• Will need to bill from multiple applications

• Manage billing to the appropriate Payers

• Apply cash from various sources

• Work denials in multiple applications

How will your staff work efficiently in this environment?

Consequences of MLTC Choice in an Open Model

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MLTC – Choice: Practical Challenges

MLTC 1 MLTC 2 MLTC 3 MLTC 4 MLTC 5

Aggregator

Agency

CaregiverApplication 1

Application 2

Application 3

Application 4

Application 5

Five feeds to the Aggregator(one for each EVV vendor)

Five different EVV applicationsused by caregivers (one for each EVV vendor)

Five different EVV applicationsused by Agency staff for VisitMaintenance, Billing, and Cash Posting (one for each EVV vendor)

Five different interfaces for Auths, EVV, Invoices, Remits (one for each EVV vendor)

State Access

Worst and Most Complex Scenario• Each MLTC chooses a different EVV Vendor• State selects an Aggregator solution• Agency chooses to use the solution mandated by

each payer

Consequences• Untenable environment for the Agency and the

Caregivers• Complex integration scenario for MLTCs, Agencies,

and the State• Compliance challenges

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Recommendation: Simple, Proven, Effective

MLTC 1 MLTC 2 MLTC 3 MLTC 4 MLTC 5 Aggregator

State EVV or Agency EVV

CaregiverCaregiver uses a single application provided by the State EVV Vendor or the Agency EVV Vendor

Agency uses State EVV, or the Agency EVV application for Visit Maintenance, Billing, and Cash Posting

Single interface for Auths, EVV, Invoices, Remits

State Access

Best Case Scenario for All Constituents• MLTCs leverage the State EVV vendor• State selects an Aggregator/EVV solution• Agencies can use State EVV solution, or

another EVV solution if they choose

Consequences• Fewest number of interfaces• Cheaper for MLTCs and Agencies• Least complex solution, proven in other states• Agencies have an EVV choice• State has consistent view of ALL EVV data

across MLTCs

Agency

State EVV or Agency EVV Application

Open Model with Closed Billing

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Background - Stating the Obvious:• Most of the focus to-date has been on Personal Care Services• Home Health agencies have more stringent accreditation requirements,

compared to agencies that are delivering Personal Care Services• The workflow for Home Health agencies is designed for compliance• EVV for Home Health agencies can have unique implications on workflow

The “Open Model” is different for each vendor• Beware…some Payer solutions:

• Allow agencies to use a 3rd party POC or EVV solution, but require agencies to bill from their system

• This is an Open EVV model, but NOT an Open Billing model!

• This combination has dire consequences for Home Health agencies

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MMIS System

Billing Scheduling EVV BillingSchedulingEVV

Third-Party Systems

Stack

Claims

Jurisdictional Reporting/Business Intelligence, Claims, Quality Oversight and Management Dashboards

ALL PAYERS (State and MLTCs)

837s directly integrated with MMIS

Normal Billing Process

Payer Data

State

Solution

Data

Third-Party Data

State Provided EVV Solution

Data Flow: Open EVV with Open BillingA Single Aggregator, at the State level, Accessed by ALL Payers

Challenges of Open EVV, Closed Billing

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• If billing must be completed in the “state provided” system

• How will a Home Health agency ensure that billing is held until Physician Signature is received?

• How does this impact Accreditation and Audits?

Example #1

Billing Hold Until Receipt of Physician Signature


• How will a Home Health agency ensure that they are billing the proper amount to the state, as opposed to the third party?

• How does this impact Accreditation and Audits?

Example #2

Third Party Liability


• How will any agency manage their cash application process and claims reconciliation process?

• How does this impact your operations and profitability?

Example #3

Remittance Reconciliation and Applying Cash Received

The Definition of an “Open Model” Is NOT Consistent Specific Challenges of “Open EVV” with a “Closed Billing” environment

Confidential and Proprietary www.sandata.com

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Gotcha’s, Based on Experience

Consistent Issues We’ve Encountered

1. Procrastination

2. Lack of focus on Payment Integrity

3. Underestimating the positive aspects of Technology

4. Overestimating the positive aspects of Technology

5. Underestimating the capabilities of Caregivers

6. Assuming the State is aware of Provider Workflow

7. Open isn’t necessarily Open

8. Don’t take Interoperability for granted

9. Don’t underestimate the difficulty of Interoperability

Avoiding Gotcha’s: Communicate and Avoid Assumptions

• Bookmark the NYSDOH EVV website: www.health.ny.gov/evv– Calendar of events– FAQ’s– Future stakeholder engagement opportunities will be posted

• Sign up for EVV listserv

– Email to: [email protected]– In Subject Line “SUBSCRIBE EVV-L FirstName LastName

• General feedback and comments: [email protected]

• Stay informed

• If you don’t have EVV today, WAIT

• Think about change management and how EVV will effect current day processes


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Best Practices to Begin Preparation

http://www.health.ny.gov/evv

mailto:[email protected]


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The Role of Associations and Providers

• Have a plan

• Be visible…Be engaged early

• Make Some Noise

• Avoid becoming a “victim”

• Avoid “threats”

• Work with the EVV Vendor(s)

• Understand the personality of your state Medicaid Agency

• Learn from other states

• Arm yourself with accurate data

• Arm your constituents with accurate data

• Maintain a sense of humor

www.sandata.comConsistent Communication and Collaboration


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Thank you

STEVE PELLITOEmail: [email protected]: (516) 484-4400 Ext.4175


Documents

Are You Ready for EVV? · Worst and Most Complex Scenario • Each MLTC chooses a different EVV Vendor • State selects an Aggregator solution • Agency chooses to use the solution