Responses to the Electronic Visit Verification Notification to Clients (EVV)

Department of Social Services (DSS) has announced plans to implement the Electronic Visit Verification (EVV) System for the Acquired Brain Injury (ABI) Waiver. Concerns have been raised by agencies that provide ABI Waiver services, but there are also significant concerns regarding the impact the new EVV/billing system will have on participant’s lives.

Centers for Medicare and Medicaid Services (CMS) urges that all states agencies allow waiver participants and/or conservators the opportunity to direct some or all of their waiver services. Self-direction of services allows participants and/or conservator to have the responsibility for managing all aspects of service delivery in a person-centered planning process. The EVV system proposed by DSS does NOT allow for person centered planning and in fact will either endanger participants’ health and welfare or fully restrict and control their daily lives and schedules.

Dear Brain Injury Community,

Attached is the letter sent to Department of Social Services Commissioner Bremby regarding the impact of the new electronic visit/service/billing verification system (EVV) Dear Commissioner Bremby.

The ABI Waiver is unique in that it offers an array of services that most participants use on a daily basis. As services and rates change throughout a participant’s day, a single staff member can have the training and expertise to provide most if not all of the services. This means that participant’s lives are not interrupted or impacted due to any DSS required billing/visit verification system.

For example, a participant’s day may be broken down in the following way:

6am-7am – Recovery Assistant Service
7-am-9am – Companion Service
9am-12pm – Independent Living Skills Service
12pm-3pm – Prevocational Service
3pm- 10pm – Independent Living Skills Service
10pm-11pm – Recovery Assistant Service
11pm – 6am – Companion Service

ALL of the above times/services are moveable and flowing according to the day, spontaneous plans a survivor may have, holidays, events, etc.. NONE of the service times and changes require constant logging in and out of hours and do NOT in any way impact a participants life, day, plans, etc.. At this point, prevocational and supported living service are not part of the EVV system, but the before and after services will still need to be logged in and out.

With the new EVV system, participant’s lives are about to dramatically change. For example, if a waiver participant has an appointment at 9:15 AM and a service change takes place at 9 am (e.g., Companion hours to Independent Living skills Hours), staff must log out from one service, and log back in for the new service on a portable electronic device (e.g. cell phone or tablet). This act, needing to be done while transporting the participant to an appointment puts disabled brain injury survivors lives at great risk – the “logging in and out” is more dangerous than texting or talking on the phone while driving! In addition to logging in and out, all service changes that take place in the community cannot be logged in unless a GPS “location tracker” is opened and activated on the electronic device. I am aware that agency managers can “override” and make adjustments to hours, but the fact that there is ANY chance staff will log in/out while driving/transporting a participant is completely unacceptable and dangerous. Pulling over to the side of the road is unacceptable and a dangerous situation as well.

The alternative to this type of logging in and out is no better as brain injury survivors will be forced to be AT HOME for every single service and/or staff change so that logging in and out of services and hours can be done by equipment installed at the participant’s home. Requiring an ABI Waiver participant to be AT HOME for all staff/service changes is a violation of their rights, self-direction and person-centered planning.

I am also deeply concerned regarding crisis situations, if a participant goes into a crisis situation during a required “log in and out” staff will now have to make a decision as to whether to attend to the crisis or “log in hours” while making sure their “location tracker” is on. In many cases, where a crisis can escalate VERY quickly, a split second could be the difference between a life and death situation. The system DSS is implementing was never designed for a multi services, complex, 24 hour a day program like the ABI Waiver, it is not only dangerous, it is intrusive and an invasion of a brain injury survivor’s privacy. Brain injury survivors are also objecting to the invasion of their privacy and do NOT feel their locations/friends/activities, etc., should be tracked by the state of CT or Hewlett Packard when staff uses a GPS system to log in and out of their hours/services.

The EVV system appears to be very appropriate for a visiting nurse or other “in home” daily care/therapy/homemaker visits and services, but it is not appropriate for people receiving extensive services while living full, independent lives in the community..

Below are emails that I sent to the department of social services with some of the concerns I have; response from the state is in bold letters;

The responses I got form this email

Mr. Sears- I have attached some documents for your review. The first is a picture of what the FVV looks like with some info on how it works, a lengthy document of Frequently Asked Questions from the providers that the Department has addressed and lastly a list of reason codes that an agency enters when services are not delivered or are delivered in a location where check in and checkout cannot occur.

FVV: The Fixed Visit Verification system (FVV) would require me to travel home at each shift change or the agency gets hit with an error.

1. If I do not make it home in time for the change in shift does the agency receive an error in the system? If thr care provider does not check in or check out an exception is created and the provider agency would have to manually go in to the system and correct this. They would have to provide a reason code from the list I attached to indicate why this occurred.

2. How do these errors impact the agency? The agency would have to go in and correct this. There is no impact on the them.

3. What is to stop the agency from demanding that I return home at each shift change so they do not have an error? Your services are person centered and this should not even be an issue. Agencies cannot mandate a person return home and the Department is not endorsing this.

4. Does DSS want me to return home just to keep the agency from having an error? No- See above

MVV: The tablet system tracks my location. I cannot accept that I will be tracked. But I have questions. – The MVV system does not trach your location but the location of the visit check in and checkout

1. If the staff log-in or log-out while I am away from home is this an error? The GPS component of the MVV has to match the address that is on file with DSS, again like FVV it would create an exception for the agencies administrative staff to correct.

2. How do these errors impact the agency? They are required to manually enter a reason code as above.

3. What is to stop the agency from demanding that I return home at each shift change so they do not have an error? See above for FVV

4. Does DSS want me to return home just to keep the agency from having an error? Absolutely not

Telephony: The phone system is also unacceptable to me because I do not want staff using my phone nor do I want the system connected to my phone. I have the same questions regarding the phone as I do about the FVV: All the answers to these questions are the same as the above for FVV. This system is not intended in any way to impact the care you receive.

Please let me know if you have further questions or clarification is needed on anything and I would be happy to respond.

Amy Dumont, LCSW
Department of Social Services
Community Options
55 Farmington Ave.
Hartford, CT 06106

The same day I sent an email saying.

Amy Dumont all the information you sent me was about ABI providers… I am NOT a provider I am the brain injury survivor/ employer of a person-centered program, I have six questions that I need answered.

Mr. Sears:

In response to your concerns please see below-

The responses I got

1. Are you saying that December 1, 2016 is not the start date? Start date is 1/1/17

2. Please provide the legal basis that requires me to use EVV with my employees and the agency that I have hired. The requirement is of the provider agency and the agency is contracted with the department as a Medicaid provider

3. Is DSS the employer of my providers or am I the employer? The agency is the employer

4. If DSS is not the employer what legal basis do you have to dictate that the company and providers I hire use a system that I do not want? The providers have a provider agreement to provide services to Medicaid recipients

5. Are you denying me services if I refuse to allow my hires to use EVV? The department is not denying anything to the waiver participant. The agency will make a decision on whether to provide services if they are unable to comply with department requirements.

6. Please explain how your requirement does not violate my rights under Person-Centered programming? The Medicaid home and community-based person-centered requirements relate to the process and development of the service plan. There is nothing in the person-centered requirements that would prohibit the Department from selecting the billing verification process for participating providers, or permit a Medicaid client to select his or her own billing verification process. Rather, the responsibility for verification of providers’ billing rests with the State. If the provider can’t comply with the department’s requirements, they will not continue to provide services.

Amy Dumont, LCSW
Department of Social Services
Community Options
55 Farmington Ave.
Hartford, CT 06106

MY Response to to DSS & EVV;

Hi Amy, Kathy, and Clement,

CMS has established that I have rights in my home and you are attempting to violate those rights but I will not allow it. I do not need to provide you with a detail of my rights as they are in your documents and CMS’ documents and it extends beyond Person-Centered Planning.

• I have the right to control my schedule and I plan to exercise my rights. Please note the following;

o Staff are not allowed to start their shift until they are with me.
o EVV cannot be used in my presence.
o Staff cannot sign-on or sign-off on the EVV system in my presence or on my property.
o Shift does not end until staff leaves my presence.
o Between the time staff starts their shift and the time that their shift ends they are not allowed to have anything related to EVV with them.
o I am in control of my living environment and staff are not allowed to bring any EVV related materials to my home address.
o If DSS authorizes a provider to use EVV on my property or in my presence without my prior approval I will report the violation to CMS and ask my advocate to take any action necessary to resolve the issue.

EVV is now the problem of DSS and the agency provider. My position is unchanged. The agency cannot bring on my property or into my home any software or device that violates my rights regarding my home.

New Day Home Care will have errors. They will need to correct those errors if they are to be paid. The responsibility lies with them not with me. I have given everyone my rationale. I consider this matter closed.

Craig Sears