Recently, the Centers for Medicare & Medicaid Services (CMS) announced a simplified, outcomes-based approach to certifying EVV systems for Medicaid personal care and home health services.
In the past, CMS certified EVV systems using the Medicaid Enterprise Certification Toolkit (MECT), which has 146 certification evaluation criteria and includes project initiation milestone reviews. The new approach streamlines this process by reducing the certification evaluation criteria from 146 to 11 and eliminating the project milestone reviews.
The new certification process is focused on the following:
Outcome statements describing the desired results once the system is implemented. CMS-provided outcomes are based on the six data elements listed in section 1903(l)(5) of the Cures Act.
Evaluation criteria and required evidence. These correspond to outcome statements and are used by a state and CMS to evaluate the system’s functionality and its compliance with laws, regulations, and industry best practices.
Key Performance Indicators (KPIs). These metrics support the outcome statements and are used to track the performance of the system over time. There are 5 KPIs required for certification and continued reporting.
For a detailed listing of the different requirements and how states will need to measure and report on them, you can refer to the document titled “02 EVV Certification 1.0 Evaluation Criteria and KPIs” on the Medicaid website.
In addition to reducing the number of certification evaluation criteria and removing the project milestone reviews, the new process for EVV certification is simplified in the following ways:
Streamlined Reviews. States undergo an Operational Readiness Review before the system goes live. At least six months later, a Certification Review is conducted.
Introduced Quarterly KPI Reporting. The state reports on KPIs at least once after the Operational Readiness Review and then quarterly after certification. Quarterly reporting is required for as long as a state continues to receive enhanced funding for operations and maintenance.
Reduced Artifacts List. Except for the certification request letter and system acceptance letter, the state does not need to prepare artifacts listed in MECT Appendix B, nor does it need to prepare a Project Partnership Understanding.
EVV certifications will be structured around two business-related outcome statements, Preventing Fraud and Availability & Accessibility, and one enterprise outcome statement, Privacy & Security. A state will demonstrate its EVV solution’s achievement of these outcomes through 11 evaluation criteria and five KPIs, which are noted in the chart below.
Source: Centers for Medicare & Medicaid Services
CMS also outlined the overall certification process and timeline, which has a specified 6-month live period before the system can get certified.
While previously a labor intensive and time-consuming process driven by the MECT Toolkit and artifact collection, the transition to an outcomes-based certification for EVV gives states a clear and direct path to achieving EVV certification. This first-of-its-kind outcomes and reporting based certification will not only help to drive adoption of EVV, but also continue to raise the quality of homecare by focusing on value and outcomes-based metrics. Advanced EVV solutions such as HHAeXchange, which can demonstrate their ability to meet CMS criteria and KPIs, reduce the burden on states during certification and help ensure the goals of EVV are met.
For more information on EVV certification requirements, visit the Medicaid.gov EVV page.
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