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Series: Electronic Visit Verification System for Medicaid In-Home Services

Announced on  | Last Modified on  | Series Number: W-00-24-31564
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

All States were required to implement an electronic visit verification (EVV) system for personal care services (PCS) by January 1, 2020, and for home health services by January 1, 2023. CMS granted the vast majority of States a 1-year extension (to January 1, 2021) for meeting EVV requirements for PCS. EVV was developed to address weaknesses in PCS that contribute to improper payments, questionable quality of care, and significant fraud. Our objectives will be to determine whether selected States: (1) implemented an EVV system according to Federal and State requirements, and (2) complied with Federal and State requirements when claiming Medicaid in home PCS.

There are 3 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (2)

Project A-06-24-05005 • Announced on May 23, 2024

Project A-07-24-03260 • Announced on Sep 11, 2024

COMPLETED PROJECTS IN THIS SERIES (1)

Review of Electronic Visit Verification for Medicaid Personal Care Services in Kansas

Project A-07-23-03255 • Completed on August 20, 2024

TIMELINE

  • October 3, 2022
    Series Number W-00-24-31564 Assigned
  • October 3, 2022
    Project Announced

    Review of Electronic Visit Verification for Medicaid Personal Care Services in Kansas - A-07-23-03255

  • May 23, 2024
    Project Announced

    Project A-06-24-05005

  • August 20, 2024
    Project Complete - A-07-23-03255

    Review of Electronic Visit Verification for Medicaid Personal Care Services in Kansas has been marked as complete. This audit resulted in 4 recommendations.

  • September 11, 2024
    Project Announced

    Project A-07-24-03260

  • Today
    2 Audits In-Progress
  • Est FY2026
    Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

Kansas’s Implemented Electronic Visit Verification System Could Be Improved (A-07-23-03255)

24-A-07-099.01 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the Kansas Department of Health and Education improve its electronic visit verification system by developing and implementing procedures to verify that in-home PCS claims are recorded and verified in its EVV system, and implementing edits to verify that tasks recorded on in-home PCS claims match allowable tasks approved in the PCSP.    

24-A-07-099.02 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the Kansas Department of Health and Education improve its use of the EVV system by verifying that exceptions are reviewed and remedied,  requiring that providers use the scheduling function within the EVV system or else directing the EVV contractor to remove the corresponding exception for instances when the scheduling function is not used, training providers on how to address and minimize the occurrence of informational exceptions, and establishing formal requirements governing service workers' use of the web portal.

24-A-07-099.03 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the Kansas Department of Health and Education verify that providers are complying with the State agency's established policies and procedures to maintain documentation showing that service workers are registered, screened, and employable pursuant to background check requirements.

24-A-07-099.04 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the Kansas Department of Health and Education verify that MCOs are complying with the State agency's established policies and procedures to complete and reassess functional needs assessments, including the needs evaluation tool, every 12 months, and upload these documents into the care management system for retention.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Information Technology and Cybersecurity Non-institutional care Quality of Care
Target Groups
-
Financial Groups
Medicaid