Electronic Visit Verification (EVV) System FAQs

The content on this page was updated on Oct. 23, 2024.

Overview 

What is Electronic Visit Verification?

Electronic Visit Verification systems (EVVS) verify by a phone, fixed device, or computer-based system that personal care, home health and other home and community-based services (HCBS) are being provided.

Why implement EVV?

Health and Human Services (HHS) implemented EVV to comply with the federal 21st Century Cures Act. EVV is mandatory for Medicaid programs in all states. The Centers for Medicare and Medicaid Services (CMS) fines state programs who do not comply with EVV. 

What is the federal 21st Century Cures Act?

Section 12006(a) of the 21st Century Cures Act mandates states implement EVV for all Medicaid personal care services and home health services that require an in-home visit by a provider. This applies to personal care services provided under sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k), and Section 1115 and home health services provided under Section 1905(a)(7) of the Social Security Act or a waiver.

When was EVV implemented?

• Medicaid-covered personal care and related services was effective January 1, 2021.
• Medicaid-covered home health services was effective January 1, 2023.

What information does EVV verify?

Section 1903(l)(5)(A) provides that the system must be able to electronically verify, with respect to visits conducted as part of personal care services or home health care services, the following:

1. Type of service performed,
2. Individual receiving the service,
3. Date of the service,
4. Location of service delivery,
5. Individual providing the service; and 
6. Time the service begins and ends.  

States often choose alternate titles for personal care services or bundle them within other service definitions (ex: respite, in-home living supports).  Is the Cures Act definition limited to just those services explicitly titled “personal care services” in a state’s state plan or waiver program?

All services requiring an in-home visit are included claims under the home health category or personal care services category on the CMS-64 form are subject to the EVV requirement.  In addition, services furnished under waivers or demonstration projects that meet the statutory or regulatory definition of a “home health service” or “personal care service” must meet the EVV requirement, even if they are bundled into a different service or furnished through a managed care provider.  In other words, if the service includes personal care services or home health services, even if it has a different name or also includes other services, it is subject to EVV.

What programs and services does the EVV affect?

The definition of “personal care services” is not uniform across all the authorities under which it can be covered as a Medicaid benefit, but in general, it consists of services supporting Activities of Daily Living (ADL), such as movement, bathing, dressing, toileting, and personal hygiene. Personal care services can also offer support for Instrumental Activities of Daily Living (IADL), such as meal preparation, money management, shopping, and telephone use.
This affects home and community-based services (HCBS) administered by the following sections:

• Medical Services
  • Autism Spectrum Disorder
    • Respite (provider managed)
    • Respite (self-directed)
  • Children’s Hospice 1915(c)
    • Respite (provider managed)
  • Medically Fragile Children’s Waivers
    • In-home Support (self-directed)
• Traditional IID/DD Home and Community Based Services
  • Adult Family Foster Care – Respite Care
  • Extended Home Health Care
  • Homemaker
  • Independent Habilitation
  • In-home Support (provider managed)
  • In-home Support – secondary staff (provider managed)
  • In-home Support (self-directed)
  • Respite (provider managed)
  • Respite (secondary staff) (provider managed)
  • Respite (self-directed)
• 1915(i) State Plan Amendment
  • Respite Care
• Home Health
  • Home Health Aide
  • Physical Therapy
  • Physical Therapy Maintenance
  • Physical Therapy PTA
  • Occupational Therapy
  • Occupational Therapy Maintenance Program
  • Occupational Therapy OTA
  • Speech Therapy
  • Speech Therapy Maintenance Program
  • Skilled Nursing (LPN)
  • Skilled Nursing (RN)
  • RN Care Training/Education
• Adult and Aging Services
  • Chore Labor
  • Chore Labor (two person assist)
  • Companionship
  • Extended Personal Care
  • Extended Personal Care (Nurse)
  • Homemaker
  • Homemaker (two person assist)
  • Non-Medical Transportation
  • Non-Medical Transportation (Escort)
  • Nurse Education
  • Personal Care (unit rate)
  • Personal Care (unit rate) (two person assist)
  • Respite Care
  • Respite Care (two person assist)
  • Supervision
  • Supervision (two person assist)
  • Transitional Living

Provider Questions 

Which providers must use EVV?

• Agency Qualified Service Providers (QSPs)
• Individual QSPs
• Licensed Developmental Disabilities (DD) Providers
• Children’s Medically Fragile, Autism Spectrum, Children’s Hospice (respite care providers)
• 1915(i) In-Home Respite Providers
• Home Health Agencies
• Traditional IID/DD HCBS Waiver Self-Directed In-Home Support and Respite Providers

Who is the aggregator vendor in ND?

Sandata Technologies is the aggregator vendor contracted in ND.

Who is the EVV vendor in North Dakota?

North Dakota (ND) contracts with Therap LLC as its EVV vendor. 

Are providers required to use Therap’s EVV technology?

No. HHS uses an open EVV model. Agency providers may choose to use their own EVV system and are required to submit data to a data aggregator.  Only one EVVS can be used by an agency provider at any given time. Multiple EVVS cannot be used simultaneously, even if the agency provider wants to track different EVV services data within each system. (See section titled “Providers Using a Third-Party EVV Vendor” below for more information.)

Please note, although not required to use Therap for EVV technology, all agency QSPs are required to use Therap to acknowledge service authorizations and complete Critical Incident Reports (CIRs), also known as General Event Reports (GERs), within the Therap system.  If using Therap for EVV technology, you must bill for EVV services within Therap. If Therap is not your agency’s EVV vendor, you can bill for EVV services through the Medicaid Management Information System Portal (MMIS) or through another billing system, but you cannot bill for EVV services within Therap.

Is there a cost to me for using Therap’s EVV system?

No. There is no charge to any provider or individual to use the Therap EVV system; however, there may be a cost to agency providers who choose to use their own alternate EVV system or for the technology or other devices required to collect data during a visit. 

I am an agency provider under Adult & Aging Services and would like to switch to a different EVV system. Am I able to do this?

Yes, ND has an open EVV model, an agency can choose to switch EVV systems at any time but only one EVVS can be used by an agency provider. Multiple EVVS cannot be used simultaneously, even if the agency provider wants to track different EVV services data within each system. Any switches involving Therap require a minimum three weeks’ notice to HHS to process. The agency must notify HHS by sending an email to Adult and Aging Services at dhshcbs@nd.gov to start this process. 

What options does Therap, LLC use to capture EVV?

• Mobile application (Online and/or offline) using smart phone or tablet
• Web application on computer (online only)
• Interactive Voice Response (IVR)
• Fixed Visit Verification (FVV) – Pre-Approval from State required
• Tertiary (paper attached to electronic record) - Approval from State required

What technology do I need to use Therap’s mobile application?

• Android version available for free on Google Play
• Requires Android 5.0 or higher
• iOS version available for free in Apple App Store
• Requires iOS 10.0 or higher

How does Therap LLC protect information?

Protected health information (PHI) is not stored on a mobile device for EVV, even offline. Login credentials are individual user specific, and privileges are role and caseload based.

Can I use a Kindle?

No, Kindles are not compatible with the Therap mobile application.

Are agencies allowed to require their workers to use their personal cell phone for work?

Please see the Department of Labor fact sheet on Deductions From Wages for Uniforms and Other Facilities Under the Fair Labor Standards Act (FLSA) for additional guidance applicable to this scenario. For labor law questions, provider agencies may wish to consult with an attorney.

Are agencies responsible for cell phone or data charges if the worker is using a mobile device to record their visit?

Please see the Department of Labor fact sheet on Deductions From Wages for Uniforms and Other Facilities Under the Fair Labor Standards Act (FLSA) for additional guidance applicable to this scenario. For labor law questions, provider agencies may wish to consult with an attorney.

If services are provided outside of the person's supported home and the provider uses Therap to check in, will the provider be out of compliance?

Staff can check in from any location using the web or IVR from a cell phone if they are providing care to the individual.

Is the client required to verify the visit with their signature or voice verification?

No, client signature or voice verification is not required. However, clients may verify via either of these methods if they choose.

When using an FVV device, the numbers on the device must be inputted into Therap on the computer. How do we input this information if staff do not have this capability?

Numbers from the FVV device can be captured on a form and the staff submit it to their supervisor who enter it in Therap. Individual providers are responsible to have access to a computer or smart phone where to enter the fixed object numbers.

Does IVR need to be used with a landline only?

IVR does not need to be done from a landline. The phone number just needs to be associated with the individual's case. There are four locations within an individual record where a phone number can be stored.

Does IVR need to be pre-scheduled?

Yes. To utilize the IVR option, the visit needs to be prescheduled in Therap to get a slot ID number to enter when calling through IVR.

Who is responsible for training provider staff to use EVV?

If you are using the ND contracted vendor, Therap LLC, they provide training and support to provider staff. If you have your own EVV system, you are responsible to train your provider staff.

Does EVV require an internet connection?

An onsite internet connection is not needed to check in and out on the mobile app. The encrypted visit information can be uploaded later when an internet connection is available. No internet connection is required for IVR or FVV.

Are employers responsible to approve employee time?

It is the responsibility of the employer to ensure accuracy and approval of employee check in and check out times.

Are provider agencies able to manually correct visit time?

Yes, if using Therap, provider agency administrators may manually update a visit when necessary. Individual QSPs can also manually correct their visit time. The system keeps track of which visits are manually corrected and the state can access a report that may be used to audit EVV data and track the frequency of manual corrections.

What happens if a worker forgets to clock in or their phone dies?

The worker should coordinate with their employer to resolve clock-in and clock-out issues. The EVV system will allow for manual entry of clock in and/or clock out times.

If I make a manual entry to correct data or add a missed punch, do I need to include the address where the care was provided?

Yes, providers are required to manually enter the address where the service started and ended on all manual entries.

If I am using Therap’s web data collection process, do I have to include the address where the care was provided?

Yes, providers are required to enable location tracking in their browser to capture the location coordinates and the address where the service started and ended on all web entries.

Will claims that are missing required EVV data be denied?

Claims that do not have the required EVV information may be denied.

What if the individual is approved for 2:1 staffing?

Staff will be scheduled in a separate slot so that they have the ability to clock in and out for the support they have provided to the person. Both slots will be billable for the services provided that were subject to EVV.

What if the staff is approved to work with two individuals for the same time?

For DD providers, if one staff is approved to work with two individuals during the same time frame, the staff will check in and out for each participant for the whole shift. Once the shift is over it can be manually changed in Therap to split the time between the two individuals. This would then be documented as an exception.

For QSPs and QSP agencies, staff are not scheduled to provide services at the same time to more than one individual.  Staff are required to check in and out for each individual every time they provide care. As you begin providing a service to one individual, check in. When done providing the service, you must check out before you can check in and begin providing services for another individual.

How do you clock in and out for transportation, when it is a non-billable service for the DD services my agency provides?

The staff will not be able to clock into the EVV system until they have arrived at the location and the EVV service is able to be billed.

What if the individual does not have a SIS score in Therap for DD services?

If the individual is new to services and does not have a SIS score, the EVV data will be kept on a paper form. Once the SIS and pre-auth are in Therap, the data will be manually entered for billing, which requires an exception code.

If this situation occurs, contact the DD State office EVV lead to:

• verify that the person does not have a SIS score
• verify they have a preauthorization
• obtain the required form

What if my unit calculations are not showing correctly?

Please note, you must work a minimum of 8 minutes to fill for a 15-minute unit. The unit amount will not show up on the check in/out schedule, but the system collects the data and doesn’t calculate the unit until the claim is created.

If Therap is my EVVS and I don’t understand the billing process, whom do I contact?

Contact the Therap help desk at ndsupport@therapservices.net.

What if I didn’t get paid or if a claim is denied?

Contact the MMIS call center at (877) 328-7098, enter 0 if you are asked for a PIN.

What if my authorization or units are wrong?

Contact the appropriate party for the program you are serving from the list below: 

What if I didn’t receive all of the units I am approved?

You won’t see the correct units until you submit the claim.

Is EVV required for the Program of All-Inclusive Care for the Elderly (PACE) program?

CMS does not interpret the EVV requirement to apply to PACE.  CMS views PACE as separate Medicaid benefit listed in section 1905(a)(26) of the Social Security Act which is not cited in section 12006(a)(5)(C) of the Cures Act.

What if my caregiver lives with me?

EVV may not be required for some services in ND when the person providing care lives with the person receiving care. With some live in care, there is no ‘visit’ to record as required by the 21st Century Cures Act because the provider lives in the home. CMS allowed states flexibility for live-in, self-directed caregivers in their June 2018 FAQ’s document:
PCS or HHCS rendered by a provider living with the resident is not considered an ‘in-home visit’ and are not subject to EVV for the following live-in services:

• 00001 – Family Home Care
• S5136 – Family Personal Care
• S5102 – Waiver Personal Care
• T1020 – Medicaid State Plan – Personal Care and SPED

Providers using a Third-Party EVV Vendor

I am an agency provider; if I already use an EVV technology, do I have to switch to the ND EVV system?

No. You may continue to use your current EVV system, but you must submit information to the data aggregator. Providers are responsible for working with the state contracted aggregator vendor to ensure all requirements are met and for any interface costs (if any) charged by their vendors if they choose to use their own system.

Providers must work with their vendor to resolve issues related to the collection or submission of EVV data.  HHS is not responsible for claims payment issues resulting from failed third party EVV integration with the State’s aggregator.

Please note, although not required to use Therap for EVV technology, all agency providers are required to use Therap to acknowledge service authorizations and complete Critical Incident Reports (CIRs), also known as General Event Reports (GERs) within the Therap system. If using Therap for EVV technology, you must bill for EVV services within Therap. If Therap is not your agency’s EVV vendor, you can bill for EVV services through the Medicaid Management Information System Portal (MMIS) or through another billing system, but you cannot bill for EVV services within Therap.

If I use an alternate EVVS and have problems with my EVV data, can the State help correct it?

If you use an alternate EVVS, you are responsible to work with that system to correct any EVV issues. The State is not able or responsible to provide technical assistance on an alternate EVVS.

I am an agency provider under Adult & Aging Services and would like to switch to a different EVVS. Am I able to do this?

Yes, ND has an open EVV model, an agency can choose to switch to a different EVVS at any time but only one EVVS can be used by an agency provider. Multiple EVVS cannot be used simultaneously, even if the agency provider wants to track different EVV services data within each system.  Any switches involving Therap require a minimum three weeks’ notice to HHS to process. The agency must notify HHS by sending an email to Adult and Aging Services at dhshcbs@nd.gov to start this process.

Who is the aggregator vendor in ND?

Sandata Technologies is the aggregator vendor contracted with ND. This system aggregates EVV data from all third-party vendors, which includes Therap.  Providers are responsible for working with the aggregator vendor to ensure they meet all requirements and for any interface costs (if any) charged by their vendors if they choose to use their own system.  Providers are responsible to review the state Alternate Vendor EVV specifications/addendum to ensure all valid data is provided to the aggregator for processing.

What date was the aggregator system implemented?

The data aggregator went live Oct. 1, 2021.

Are providers who use their own EVVS required to collect EVV data?

Yes, the 21st Century Cures Act requires all providers to use EVV to collect the six required data elements for dates of service January 1, 2021, and later. Those date elements are:

1. Type of service performed,
2. Individual receiving the service,
3. Date of the service,
4. Location of service delivery,
5. Individual providing the service; and
6. Time the service begins and ends.

Self-Directed Services (DD & Medical Services)

We receive self-directed in-home supports, who do we use for EVV?

The current ND vendor used by self-directed in-home supports and respite providers for EVV is Veridian Fiscal Solutions (VFS).

Who provides training to those using self-directed EVV services?

VFS trains and supports individuals using EVV for self-directed services. Visit https://www.veridianfiscalsolutions.org/nd/forms-resources.aspx for updates and ongoing training materials.

How does VFS protect information?

The privacy and security of the participant appointed employer and the employees they pay is of great importance to VFS. View their online privacy policy: https://www.veridianfiscalsolutions.org/nd/files/Privacy%20Policy.pdf.

Each employer of record and their employees have unique password and a VFS assigned account number to secure their time punch transactions submitted through the EVV platform. VFS also uses secure email to protect all confidential and protected health information in transit and at rest when emailing participants. VFS has security procedures in place for all requests for information written and verbal. Our locations are secure and all confidential and protected health information is encrypted on VFS systems.

Is an internet connection required for self-directed EVV?

Veridian uses two options to collect EVV data: 

• Web application (on a web browser) requires an internet connection.
• Interactive Voice Response (IVR), no internet connection required.

What if one staff is approved to work with two individuals at the same time?

If one staff is approved to work with two individuals during the same time frame, the staff will check in and out for each participant for the whole shift. Once the shift is over, staff will then be able to update the shift in the portal to split the time between the two individuals. This is then documented as an exception. A more specific FAQ for Veridian Fiscal Solutions is available online: https://www.veridianfiscalsolutions.org/nd/forms-resources.aspx.

Member and Participant Questions

Can ND choose not to implement EVV?

No. Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services and home health services that require an in-home visit by a provider. States that do not implement EVV will experience financial penalties from CMS.

Is the Electronic Visit Verification System (EVVS) tracking my movements?

No. The EVVS is not a tracking device and does not track an individual’s movements. Rather, the system records certain data elements that are required by the 21st Century Cures Act, including the location and when the provider starts and ends a visit.

Questions?

For questions on North Dakota’s EVV, contact ND Health and Human Services at carechoice@nd.gov, 
toll-free (855) 462-5465, 711 (TTY). 

Additional information is online at
hhs.nd.gov/adults-and-aging/electronic-visit-verification-evv-system.