Report Materials
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.
24-A-07-099.01 to CMS - Open Unimplemented
Update expected on
02/19/2025
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
02/19/2025
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
02/19/2025
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
02/19/2025
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
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Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.