Kansas’s Implemented Electronic Visit Verification System Could Be Improved

Why OIG Did This Audit

• As required by the 21st Century Cures Act, Kansas uses an Electronic Visit Verification (EVV) system to verify that a personal care services (PCS) service worker has arrived at a Medicaid enrollee’s residence and assisted with Medicaid-approved tasks.
• EVV was developed to address weaknesses in the PCS program that contribute to improper payments, questionable quality of care, and notable amounts of fraud.
• This audit examined whether Kansas implemented an EVV system in accordance with Federal and State requirements and complied with Federal and State requirements when claiming in-home PCS.

What OIG Found

Kansas implemented an EVV system, but it did not require all in-home PCS visits to be recorded and verified in that system and did not always comply with requirements when claiming in-home PCS.

Among other things, these errors occurred because Kansas did not:

• have procedures to prevent claimed visits from being submitted outside of the EVV system,
• have edits in its EVV system to verify that tasks performed and recorded on the in-home PCS claim matched with allowable tasks in the enrollee’s approved service plan, and
• require providers to maintain adequate documentation.

What OIG Recommends

We make four recommendations to Kansas related to its EVV system, including:

• improving its EVV system by developing and implementing procedures to verify that in-home PCS claims are recorded and verified in its EVV system,
• improving its EVV system by implementing edits to verify that tasks recorded on in-home PCS claims match allowable tasks in the enrollees’ approved service plans, and
• verifying that providers are complying with the State’s established policies and procedures.

The full recommendations are in the report.

Kansas agreed with all of our recommendations and described corrective actions that it had taken or planned to take to address them.