EVV by state: open, closed and hybrid models

The federal EVV rule says what must be verified. It leaves each state to decide how. That is why two agencies a few miles apart, on either side of a state line, can have completely different EVV setups: one must use a system the state picked, the other can use any software that meets the state's standards.

This guide explains the models states use, what each means for your choice of software, and how to find out the rules that apply to you. It does not list states one by one, on purpose: lists online go out of date quickly, and many states run different models for different programs. Your state Medicaid agency's EVV page is the only source to rely on.

The building blocks

Two pieces of software are involved in most states:

• The EVV system captures visits: the app the worker uses to clock in and out, plus the office screens to fix exceptions.
• The aggregator is the state's central store of visit data. Every EVV system in the state sends its visits there, and claims are often checked against it before they are paid.

In some states the same vendor provides both. In others, the state runs an aggregator and lets agencies pick their own EVV system, as long as it sends data to the aggregator in the required format.

The models

CMS, the federal Medicaid agency, describes several models. In everyday use they boil down to three.

Closed (state-mandated vendor)

The state contracts one EVV vendor and every agency must use it, usually free of charge. You cannot capture EVV visits in another system. You can still run your scheduling, payroll and billing elsewhere, but you will have to keep the two in step, which usually means importing or re-entering visits.

Open (provider choice)

The state sets standards and runs an aggregator. Agencies choose any EVV system that meets the standards and has been accepted by the state. The software vendor usually has to register, build the state's interface and pass certification testing before its visits are accepted.

Hybrid (state system with alternates allowed)

The state offers a free system but lets agencies use their own if it is certified to send data to the state aggregator. Many states work this way. The free system is a safe default; an alternate system makes sense when you want EVV, scheduling, payroll and billing in one place.

A fourth pattern is common in states with managed care: each managed care organization picks the EVV system its providers must use. An agency that works with several plans can end up with several systems.

What each model means for you

Model	Who picks the EVV system	What to look for in software
Closed	The state	Scheduling, payroll and billing that can import visits from the state system, so you do not type them twice.
Open	You	Certification with your state's aggregator, plus the features you need beyond EVV.
Hybrid	You, or the state's free default	Same as open; compare against the free system honestly.
Managed care choice	Each health plan	Whether each plan you work with accepts the system.

How to check your state's rules

1. Find your state Medicaid agency's EVV page. Search for your state's name with "Medicaid EVV". Use the official state site, not a vendor's summary.
2. Check the programs and services. Note which waivers, programs and procedure codes require EVV. Some states phase in services at different dates.
3. Find the model. Look for words such as "state-sponsored solution", "alternate EVV vendor", "third-party EVV" or "provider choice". If an alternate is allowed, there will be a page for vendors with an interface specification.
4. Read the alternate vendor requirements. These usually cover registration, a data use agreement, the data format, required fields and a certification test.
5. Check each managed care plan. If you bill managed care, ask each plan's provider relations team which EVV systems it accepts.
6. Note the claim matching rules. Many states deny or hold claims that do not match a verified visit. Find out what "match" means: same date, same service, units no more than the verified time.
7. Sign up for updates. States change aggregators, specifications and deadlines. Most have a mailing list for providers.

Questions to ask any EVV software vendor

• Is your system certified to send visit data to the aggregator in my state, for my programs? Can I see confirmation?
• If not, what do you provide today: an export file I can upload, or nothing?
• How do you handle manual edits and reason codes, and do you keep the original captured time?
• What happens when there is no mobile signal at the client's home?
• Do you charge per visit, per client or per worker? Are there setup fees?
• Can I export all my data, in a usable format, if I leave?

Where Ovel EVV fits today

Plainly: Ovel EVV captures all six elements with GPS, handles exceptions and reason codes, and exports EVV visit data and claim files. Live submission to a state aggregator needs certification in each state, and we set that up on request as part of the Care Connect plan, state by state. In a closed state, or until certification in yours, agencies can use Ovel EVV for scheduling, care plans, signed timesheets, payroll and private-pay billing, and use the state's system for Medicaid EVV capture. Ask us about your state before you commit.

Before you switch

Run a test week. Export your visits and check them with the free EVV visit record checker, compare exception rates, and make sure your billing can still match claims to visits. A switch in the middle of an authorization period is easier when you can see the units already used.