I. Overview of the EVV Market & Requirements Under The 21st Century Cures Act

• Under the new EVV requirements released by the Centers for Medicare & Medicaid Services (CMS), the Secretary of the Department of Health and Human Services (HHS) must gather and distribute best practices for training caregivers tasked with delivering "personal care services (PCS), home health care services (HHCS)" or both, on the operation of EVV systems.
• The Cures Act requires every state to examine the systems that work best in remote and rural (frontier) areas where cellular and internet access can be problematic; thus, hinder the delivery of EVV. Therefore, the Act does not provide an exemption on the notion of poor access to the internet.
• Regarding privacy, The Cures Act does not mandate states to record each location as the caregiver is moving through the neighborhood. Capturing the location the service delivery commenced and stopped is enough, according to the requirements of The Cures Act.
• According to CMS, states can request more information to deter fraud, waste, and abuse. While global positioning services (GPS) is one of the strategies for implementing EVV, there is no requirement to using it; instead, caregivers can rely on interactive voice response, whereby they check-in and out using a landline or cellular device at the patient's home.
• Federal funding is provided to states implementing the system or a contractor working on behalf of a state. The state can apply for federal financial participation (FFP) to receive a 90% federal match for building, developing, and installing an EVV system and 75% federal match for operating and maintaining the system.
• The required Medicaid authorities as per The Cures Act include "state plan personal care benefit; HCBS waivers; HCBS state plan option; self-directed personal attendant care services; community first choice state plan option; and demonstration."

EVV Compliance Aspects of the 21st Century Cures Act

• Despite where a state currently stands with EVV, home care providers must be ready to implement it once the state they operate in says so. However, states could request an additional year to comply with the regulations providing they had made a good faith effort.
• Therefore, home care providers need to understand the new system, implement a state-approved solution, train staff, and test the system to eliminate possible Medicaid reimbursement issues.
•  State plan home health services and home health services authorized under a waiver of the plan are subject to EVV requirements. EVV also applies to medical supplies that demand an in-home visit setup but does not apply to medical supplies picked at the pharmacy or delivered via mail.
• The use of EVV must adhere to six verification criteria that comprise the "service type, the individual receiving the service, the date of service, the location of service delivery, the individual providing the service, and the start and end times of service."
• There exist five primary models of EVV that deliver the same solutions but vary regarding the state's involvement in selecting a vendor and management. The five models are (Provider Choice Model, Managed Care Plan (MCP) Choice, State Mandated In-house System, State Mandated External Vendor, and Open Choice Model).
• On the other end, providers must decide on how to deploy mobile EVV systems considering alternatives like corporate-owned devices that are secure, reliable, and only meant for work, versus the bring-your-own-device (BYOD) model — where caregivers use their devices to verify home visits. Unfortunately, the BYOD approach can create compensation, reliability, and security challenges.

II. The Current Opportunities in the States that as of December 19, 2019, were Either Undecided Regarding EVV Implementation

Alaska

• Alaska is in the process of evaluating a qualified vendor to implement an EVV system.
• On June 08, 2020, the state's Department of Health and Social Services, Division of Senior and Disabilities Services (SDS) posted a request for proposal (RFP) for solicitation of proposals for implementing, managing, and running an EVV system.
• The state seeks to implement an "open/hybrid model EVV system."
• Since the deadline for submitting RFPs elapsed, there seem to be few opportunities left mainly for the offerors who submitted a proposal.

Idaho

• The state of Idaho is in the process of determining a vendor to run the state's EVV system. It has selected a Provider Choice model, which is compatible with the state’s aggregator.
•  DXC Technology and Sandata are the only vendors currently involved in the process. The state is now soliciting participation in each of the teams involved. The EVV implementation team claims that it may have more opportunities for participant engagement as the EVV project develops.
• To comply with EVV requirements, the state of Idaho received approval for Good Faith Effort (waiver) on November 5, 2019, extending its deadline to implement the EVV system to January 1, 2021.

Iowa

• The Iowa Medicaid Enterprise is currently working with the Managed Care Organizations (MCOs) to build and implement an EVV system.
• The state uses Carebridge technology, which offers multiple aggregation capabilities to support the existing vendors of users and integrate them with Amerigroup Iowa and Iowa Total Care.
• Currently, there are several training opportunities available, including webinars, online, in person, handouts, presentations, and support for all provider agencies.
• Iowa has remained compliant with the EVV requirements via its Good Faith Exemption request, which the Centers for Medicare & Medicaid Services (CMS) approved, extending the deadline for implementation to January 01, 2021.

Kentucky

• The Kentucky Department for Medicaid Services (DMS) is currently working with Tellus, LLC, to launch an EVV system in Kentucky. In this regard, providers will receive appropriate training on how to use the cost-free Tellus application.
• Tellus allows integration with other EVV systems; therefore, providers within Kentucky can use their EVV systems as long it is compatible with Tellus for DMS reimbursement.
• Kentucky has complied with EVV requirements via its Good Faith Exemption request approved by the Centers for Medicare & Medicaid Services (CMS) to extend the deadline for implementing an EVV system to January 01, 2021.

Maine

• Maine Department of Health and Human Services has developed an open EVV system platform.
• Providers can use the State-offered system or theirs to connect with Maine Integrated Health Management Solution (MIHMS).
• The state is providing training opportunities. Moreover, interested users can register via the state's Learning Management System (LMS) system.
• Maine's request for Good Faith Exemption was granted by the CMS, thus, extending the deadline for implementation to January 01, 2021.

Montana

• Montana is still undecided about which aggregator to use and the EVV model to adopt. The state received the Good Faith Exemption to push the deadline for implementation to January 01, 2021.
• Based on this information, it is assumed that there are an aggregator and vendor-technology opportunities in Montana State as it remains undecided on which model and aggregator to use.
• Montana's current opportunity regards its EVV system request for proposal; however, the site with the RFP is inactive. Unfortunately, the Montana Medicaid web page lacks a specific page for the EVV system.

New Jersey

• New Jersey is looking to implement an open model EVV system with broad public support and robust stakeholder processes.
• The state has finished the vendor selection process and is ready to award a tender to a contractor for a statewide EVV system.
• On December 12, 2019, the state received approval from CMS for EVV Good Faith Effort Exemption, which expires on December 31, 2020.
• As per existing information, New Jersey is on the verge of selecting a contractor; thus, it has opportunities for a state contractor.

North Dakota

• North Dakota opted for an open hybrid model for its EVV system. The open model would aggregate EVV data from the state-contracted vendor and third-party vendors.
•  Therap Services LLC received the award to become North Dakota's EVV system vendor. Meantime, the state is yet to decide on who will be its data aggregator vendor, who will be chosen via an RFP process.
• Current opportunities in the state regarding the implementation of EVV include the piloting of the EVV system with personal care providers statewide in September 2020.
• As per the most recent information regarding the EVV process in North Dakota, most of the opportunities have been acquired. The ones remaining involve the selection of the state's data aggregator vendor.

Wyoming

• Wyoming's status shows that the state is currently in the contract negotiations stage and that the contractor would be announced once they have signed the contract.
• The Wyoming Department of Health, Division of Healthcare Financing, is planning to procure an EVV technology for the state via a future Request for Proposal (RFP). In this regard, there are future opportunities regarding submitting an RFP for consideration.
• Wyoming has remained compliant with EVV requirements based on its Good Faith Exemption request, which the Centers for Medicare & Medicaid Services granted it to delay the implementation of the project to January 1, 2021.
• Since the Wyoming EVV system status is in the contract negotiations phase, it is unlikely that more opportunities regarding EVV still exist. Meantime, the state remains undecided regarding which EVV model to implement.

III. Competitive Analysis of the Current Competitive Landscape of the EVV Market

Axis Care

• Axis Care is an all-in-one homecare software solution provider with a comprehensive suite of homecare solutions, including EVV systems. It offers numerous services that range from recruiting customers to billing them.
• The company provides an EVV management solution comprising telephony and GPS mobile app that allows caregivers to collect vital visit data, including time in and out, date, location, services rendered, etc.
• Axis Care has a contract with Maine, which is using Axis Care EVV solution.; however, its solutions are available for use by other providers in the U.S. The company enjoys positive reviews and testimonials; however, none of the reviews focused solely on EVV, but on the general technology products the company offers.
• A review by Pamela S. from Mexico on the site reads, "Using AxisCare software has been a great help for our agency. It allows us to focus on our clients and caregivers instead of focusing on office management."

Axxess

•  Axxess empowers healthcare in the home setting with technologies and solutions that enhance the quality of life. It offers an extensive suite of healthcare solutions for the home.
• Axxess claims to serve over two million patients, $14 billion claims processed, 72,000 mobile app users, and over 250,000 users trust Axxess.
• The company uses a homecare software, which is available to users on both Android and IoS platforms. There is no accurate information on its website regarding the state it is serving with EVV solutions.
• Overall, Axxess elicits positive reviews among its users of homecare solutions. A review by Gina Kuenzi, Director of Nursing at Connect Home Health Pediatrics, reads, "It’s very user-friendly all of our staff love using Axxess."

ClearCare (WellSky)

• ClearCare (WellSky) is actively working to develop and provide EVV solutions for all states in the U.S. The company supports various EVV requirements for caregivers, aggregators, and payors.
• Currently, ClearCare is integrated with Florida's aggregator — Tellus and Ohio's, Pennsylvania's, Rhode Island's, and Vermont's aggregator Sandata. Equally, it has implemented a solution for Louisiana, Nevada, Oregon, South Dakota, Virginia, and Washington.
• Unfortunately, there are no reviews or client testimonials regarding Axxess EVV solution; however, based on the number of aggregators it integrates with and the number of solutions it has implemented for states across the U.S., it is likely that Axxess solution is highly rated and preferred.

Sandata

• Sandata claims to be the only "vendor with Aggregator in production in a statewide Medicaid environment." It also prides itself on being the only EVV solution provider with CMS certification.
• Sandata currently has EVV system integrations with over 90 partners. Its solutions services state Medicaid agencies as well as MCOs for Arizona, Hawaii, Colorado, Connecticut, Indiana, Illinois, Maine, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, and Wisconsin.
• Presently, the vendor has 13 active contracts with state Medicaid agencies as well as MCOs; however, there is no accurate information on Sandata's website detailing any upcoming or rumored state contracts.
• The technologies Sandata use include Santrax® Agency Management solution for data integration and Sandata Mobile Connect® for real time GPS technology.

Healthstar

• Healthstar, a CareBridge health company, offers EVV solutions via its proprietary GPS algorithms and workflow processes that accurately verify location and record time and duration of a caregiver’s visit to a patient's approved service location.
• The vendor uses CareBridge's patented EVV solution with four modalities, namely, "mobile app, beneficiary-based tablet, telephony/IVR, and fixed device," and other functionalities and customization to foster seamless user experience.
• Unfortunately, the company has not shared information regarding whether it has any current or rumored state contracts.
• Likewise, Healthstar has not featured its clients' feedback or reviews about its EVV technology performance.

FirstData

• FirstData, which is now Fiserv, uses AuthentiCare’s fully compliant technology for EVV solutions.
• The technology automates scheduling and claim submissions, tracks time (arrival & departure), and records attendance via a paperless system.
•  Alabama, Kansas, Nevada, New Mexico, Oklahoma, and South Carolina, are examples of states currently using Authenticare as their EVV aggregator vendor.
• According to FirstData, it helped deliver $12 million in program savings for Oklahoma within two years.

Research Methodology