Electronic visit verification (EVV)’s upcoming rollout in Minnesota is sparking debate between state officials, caregivers and clients over how to best implement the federally mandated system. The need to curb fraud and waste versus fears about tracking and messages of mistrusts are at the center of the debate.
One key point foes are raising is that at a time when Minnesotans with disabilities and elders are struggling to find enough care staff, the prospect of being tracked at work could be a deterrent to bring more care workers into the system.
State officials, through Minnesota Management and Budget, have come to the table with SEIU Healthcare Minnesota to understand their concerns and provide details about the federal requirements. The state has reached a tentative agreement with SEIU, according to Natasha Merz, director of the Disability Services Division of the Minnesota Department of Human Services (DHS).
Some workers and clients say they still have unaddressed questions.
EVV is required for all Medicaid-supported home care programs, under the Affordable Care Act of 2010 and the 21st Century Cures Act. It requires every state to electronically verify personal care and home health service visits. States are to collect the data on an aggregate level to monitor and address fraud, waste and abuse.
States have been implementing their programs for the past few years, with guidance from the Centers for Medicare and Medicaid Services (CMS). States have some discretion as to which programs they choose. At the direction of the Minnesota Legislature, Merz said that Minnesota is using a hybrid EVV model. It gives the choice of EVV system to provider agencies, which can choose between the state-selected EVV vendor to collect their service visit data or to purchase their own EVV system.
Providers must transmit data from their EVV systems to the statewide data aggregator so that Minnesota meets federal requirements
Delores Flynn and Ellen Wiederhoeft work in personal care. Ryan cares for her adult son; Wiederhoeft is the only full-time personal care attendant for a young child. Flynn called EVV “intrusive” and said it will create attitudes of distrust.
“This is surveillance pure and simple,” Flynn said, adding that it could take the state’s staffing crisis to “dangerous levels” if EVV deters people from seeking jobs in personal care.
“The idea of being tracked by a GPS while I am working at my job is horrific,” Wiederhoeft said.
DHS will continue its efforts to learn about the impacts of EVV on stakeholders, including SEIU and share information about progress in implementing EVV, said Merz. She also said that there is a lot of alignment between the recommendations of stakeholders that underpin DHS’s approach to EVV implementation and those expressed by SEIU. These stakeholder recommendations are captured in the legislative report that led to the state law directing DHS how to implement EVV.
“Many of stakeholders DHS conferred with to plan for EVV shared concerns about the impact of EVV on privacy because of the federal requirement that the location where services start and stop be electronically verified. While DHS must comply with the requirement to collect this data, the data collected is protected health information and subject to rigorous data protection requirements under state and federal law,” Merz said.
But clients also have objections. Darrell Paulson has relied on home care workers for 34 years. “This could complicate my daily activities,” he said. Clients fear a loss of their ability to truly have self-directed services.
Paulson explained it’s not just what he and others see as a potentially intrusive system. He cited instances where care staff have picked up groceries, prescriptions and other items en route to his home when cannot get out and do his own errands. He questioned how that would be factored in with tracking and hours.
Merz said that DHS will continue its efforts to learn about the impacts of EVV on stakeholders, including SEIU. State officials will share information about their progress in implementation of EVV.
States that have rolled out EVV programs have heard similar concerns about privacy and expenses. The Disability Scoop website reported that Alabama required caregivers to purchase tablets. In one consultant’s report, a provider agency indicated that tablets had cost $68,000. That figure didn’t include data plans needed for homes without Internet access.
In Ohio, which used military-grade cellphones with GPS monitoring capability, some clients have balked at carrying the device to facilitate visit verification wherever they receive services.
Read the DHS report about EVV at https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/long-term-services-and-supports/evv/
Legislative stories in this issue are by Editor Jane McClure