Home care agencies warn new system could cause major problems

The electronic visit verification system requires home care workers to call in when they arrive at a client's house, using a landline phone or app that shows where they are.

Nan Palmero, via Flickr Creative Commons

The electronic visit verification system requires home care workers to call in when they arrive at a client’s house, using a landline phone or app that shows where they are.

Starting Jan. 1, the state will begin requiring home care workers to use a new electronic system for reporting the time they spend caring for clients covered by certain Medicaid programs – a change forecast to save the state millions of dollars.

But home care providers say the rollout could be plagued with problems, including leaving agencies unable to pay their workers if glitches delay claims processing and payments. And one major home care agency says it will refuse to use the new system despite the requirement – and could stop serving more than 1,500 Medicaid clients if the state takes issue with its approach.

“We’re anticipating some significant problems,” said Tracy Wodatch, vice president of clinical and regulatory services at the Connecticut Association for Healthcare at Home. “If there’s any glitches, any problems with the claims getting processed, then these agencies are not going to be able to meet payroll.”

The new system is intended to provide an electronic record of when workers are at clients’ homes and the services they provide. Home care workers will call into the system when they arrive at a client’s home and use the same system at the end of the visit to report the tasks they performed.

The state Department of Social Services says the new system is meant to improve accuracy in claims and payments, and anticipates it will save the Medicaid program $8 million to $15 million per year, although some providers have questioned whether that projection is realistic.

Department officials say it will also allow home care workers to more quickly report changes in a client’s situation – such as if they need more services – and would reduce burdens clients face from handling manual timesheets.

“We’ve already begun electronic verification on a voluntary basis with over 100 home-care and home-health providers, and we’re gradually ramping the system up statewide,” DSS spokesman David Dearborn said. “The result will benefit consumers, providers and taxpayers alike by supporting performance quality measures, ensuring quality of care and enhancing monitoring of costs and expenditures.”

The new requirement applies to those providing home care services to as many as 20,000 people covered by three programs – the Connecticut Home Care Program for Elders, a Medicaid program for people with acquired brain injuries, and a separate Medicaid program that covers the cost of personal care attendants. DSS is phasing in the system – known as “electronic visit verification,” or EVV – in two steps, beginning with home care providers that perform non-medical services – such as homemaking – Jan. 1. Medical providers, such as visiting nurses, will be required to use the new system Feb. 1.

The rollout has been delayed multiple times in response to concerns raised by home care agencies.

Deborah Hoyt (file photo)

Arielle Levin Becker / CTMirror.org

Deborah Hoyt (file photo)

“The whole purpose for EVV is really important, which is to combat fraud and abuse in the Medicaid program, and we fully support that,” said Deborah Hoyt, president and CEO of the Connecticut Association for Healthcare at Home. “We just think that there’s a less expensive, less burdensome way to do it and we’re just disappointed that we can’t seem to.”

One complaint from many agencies is the state’s decision to use a single vendor, Sandata, for the system, rather than allowing agencies to provide data from their own electronic systems. They say it has been difficult and costly to create interfaces to connect their existing systems with the state’s new one, and say the Sandata system doesn’t allow many of the functions theirs do.

DSS officials have said having a single, statewide vendor allows for “integrity, consistency and completeness of information.” During an October forum on the issue, Kate McEvoy, the state’s Medicaid director, said officials thought it best to have the department oversee the system, rather than having it managed by providers themselves.

VNA Community Healthcare in Guilford, which has approximately 200 clients covered by programs subject to the new system, already uses an electronic visit verification system that’s tied to its billing and electronic health records, President and CEO Janine Fay said. When a home health aide goes to a client’s home, he or she calls into the system, which records where the aide is and the time of the call. After providing care, the aide calls back. Because the system is tied to the client’s health records, the system prompts the worker to ask if he or she did specific tasks that are part of the client’s care plan, and records it.

Once the new requirement goes into place, workers will have to go through those procedures twice – once for the VNA system, and once for the DSS system, Fay said.

“That may change, but as of right now, we can’t figure out another way to do this,” she said.

Fay said the company’s chief information officer is trying to build an interface to transfer some data to the state’s system, but she said it will never be fully automated and will instead require more manual work to reconcile issues – which increases staff time needed and raises the risk of errors.

“For us it’s a major challenge, and inefficient,” she said.

Companions & Homemakers, which has more than 1,500 clients in the affected programs, will not make the switch, said Jonathan Hunt, the company’s director of communications.

“We have no intention of utilizing this system come Jan. 1,” he said. “We cannot and will not utilize the system that they have.”

Instead, Hunt said, the company will continue providing services to its clients and billing as it currently does, with the expectation of getting paid. If the department doesn’t pay, Hunt said, the company will be forced to consider suspending services for those clients and transitioning them to other providers.

Dearborn said the department hopes Companions & Homemakers will use the new system.

“DSS looks forward to all providers taking part in this electronic verification system because, together, we need to ensure the most accurate billing and payments possible in our Medicaid program,” he said.

Companions & Homemakers, along with five other agencies, filed a lawsuit earlier this year, seeking to have the implementation delayed. Their request was denied.

Companions & Homemakers currently uses paper time records. Hunt said the company would consider moving to an electronic system, but only if it can choose and contract with the vendor, giving the company recourse if the system goes down or a data breach occurs.

Another concern Hunt and other providers have cited: the DSS system uses five digits from workers’ Social Security Numbers to identify them, which Hunt said has worried many employees.

What are DSS’ expectations for how the rollout will go? And are there any plans for addressing or preparing for potential issues that could arise?

“As providers have identified systems issues, they have been addressed,” Dearborn said. “There are some further enhancements providers have requested, and we plan to implement once we receive final approval from [the federal Centers for Medicare and Medicaid Services] for those enhancements.”

Dearborn also noted that the department has requested that providers try out the system to learn how to properly use it, and said they have had access to web-based and in-person training on the new system and a customer care line to address questions.

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