In the waning days of the 2016 legislative year, Congress passed the 21st Century Cures Act that represented a significant investment in improving access and availability of mental health services nationally. Included in this legislation was a last minute addition titled Electronic Visit Verification (EVV) in Section 12006.

It’s largely believed that this addition that required a “pay for” was driven by the EVV vendor lobby; principally Sandata corporation. Section 12006 requires states that have personal care services programs to additionally report the type of service performed; individual receiving the service; date of the service; location of service delivery; individual providing the services and time the service begins and ends. This requirement is, at the very least, a burden on every Medicaid agency in the country.

Why would this invasive reporting requirement completely unrelated to mental health services be included in the law? Ultimately it was because a few large healthcare corporations knew they could make a lot of money by requiring state Medicaid agencies to report this new information and companies like Sandata and Optum had the software and training available to implement it albeit for a hefty price.

In order to justify this burdensome reporting requirement company lobbyists alleged fraud, waste and abuse in the personal care services program was extensive and could be stopped by using their software. The Industry along with congressional staffers even went so far as to come up with a figure of approximately $125 million that could be “saved” over a ten-years by requiring EVV. This amount based on absolutely nothing became a pay for essentially guaranteeing that it will save that much in 10 years. To sweeten the deal, the legislation appropriated Medicaid funding to the states to purchase software and for ongoing maintenance.

During a congressional oversight committee hearing the Congressional Budget Office (CBO) was asked about the $125 million pay for and how it was determined. CBO had no credible evidence to support the allegation that there was a high-level of fraud, waste and abuse in the personal care services program. Based on that, the panel declared the projected “savings” as flawed and unacceptable. Since that time no substantive/credible findings of fraud in the consumer directed personal care services program has been made available by CBO yet states continue to interpret location as using GPS and biometrics in the name of program integrity. Program integrity is code for fraud, waste and abuse.

The myth was exposed. Undaunted, the EVV industry went to work on state Medicaid agencies, who in many cases were willing partners, selling their software and programs that use GPS or biometrics in order to report the time and location of workers providing services. The software is not new to the home care industry and is used often by home care agencies to monitor their employees. It is, however, new to and absolutely contrary to the personal care services program for consumers who direct and employ personal care services workers.

It's one thing if an agency like Home Health Care wants to track their employees but forcing this model on the consumer directed personal care services program is antithetical to consumer control and choice. The EVV Industry and state Medicaid agencies are getting strong pushback from the disability and elder communities as a result. EVV legislation does not require the use of GPS and biometrics in the location provision. Thus, for example, California uses a web portal for EVV that does not require GPS or biometrics and simply addresses the location provision by requiring that the worker and consumer indicate whether the service was delivered in the home, community or both. This method is acceptable to the disability and elder communities because it preserves worker and consumer privacy rights. Equally as important is that workers much prefer this approach and are more likely to continue working in the field.