May___, 2018

Ms. Seema Verma

Administrator
Center for Medicare and Medicaid Services (CMS)
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, D.C. 20201

Dear Administrator Verma:

We are writing to express serious concerns about the interpretation and implementation of the
Medicaid Electronic Visit Verification (EVV) provisions in Subtitle C, Title XII, Section 12006
of the 21st Century Cures Act. (P.L. 114-255). A significant delay in implementation is needed
to protect privacy rights, reduce administrative and financial burdens for providers, and give
clear, independent guidance to state medical agencies. Additionally, in accordance with
congressional intent, the scope of application should be limited to exclude individuals with
Intellectual and Developmental Disabilities (I/DD) in group home settings.

In response to an analysis from the Office of the Inspector General on Medicaid-funded personal
care and home health services, on a bipartisan basis, Congress included EVV provisions in 21st
Century Cures Act to require states to verify the provider, date, time, and site of personal care
and home health services.

Congress directed the Center for Medicare and Medicaid Services (CMS) to issue guidance at
least a year in advance of the implementation deadline of January 1, 2019. Yet less than eight
months before the implementation deadline, there is an alarming lack of clarity on a number of
basic requirements of the EVV program. For example, despite Congressional intent that EVV
was only intended to cover personal care services and home health services provided in a
person’s own home, CMS has failed to clarify that EVV should not include the aforementioned
services provided in other settings outside the home, such as work or school, or other licensed
residential settings that have other regulatory protections already in place. Other basic questions
remain, including about how EVV requirements apply when services are provided in multiple
locations during a shift. There are serious privacy concerns due to lack of clarity in
implementation. Specifically, EVV systems are tracking the location of consumers and their
caregivers engaging in everyday activities throughout the community, like grocery shopping,
running errands, and participating in recreational activities. This has been a particular concern in
consumer-directed programs, and again, seems to conflict with congressional intent.
In light of these and other issues, it is clear that states need more time to responsibly and
effectively implement EVV. Rushed implementation of EVV to comply with the unrealistic
January 1, 2019 deadline for personal care services ultimately hurts consumers. Additionally, in
accordance with congressional intent, individuals with I/DD in group home settings should not
be subject to EVV requirements.

Thank you for your attention to this important matter.

Sincerely,