Response to Comments

Electronic Visit Verification Compliance Survey
CMS-10680, OMB 0938-New
Response to Public Comments
The Centers for Medicare and Medicaid Services (CMS) received three comments in response to the
public comment request for the Electronic Visit Verification (EVV) Compliance Survey posted to the
Federal Register on October 5, 2018. Two comments were from individuals expressing concerns with
EVV statutory requirements. The third comment was from an advocacy group called the Consortium for
Citizens with Disabilities and it suggested that the EVV Compliance Survey be amended to include
specific questions linking back to statutory requirements to ensure that EVV systems are minimally
burdensome, protect privacy, and do not inhibit community integration. Additional details and CMS’
responses to each of these comments are outlined below:
Comment 1: This individual expressed opposition to EVV citing invasion of privacy and unfair burden on
individuals with disabilities.
CMS Response: EVV requirements were included in the 21st Century Cures Act, and any changes to
these requirements would require an act of Congress. While CMS acknowledges your concerns, CMS is
responsible for implementing the laws passed by Congress. CMS appreciates this feedback and
participation during the comment period.
Action(s) Taken: CMS has and will continue to provide guidance to states on EVV implementation.
Please visit the CMS EVV website for guidance issued to date.
Comment 2: This individual expressed concerns with EVV implementation at the present time due to
privacy issues, lack of connectivity in rural areas, and waiting lists or cuts for home and community-based
services, and specifically asked 1) why states should be penalized, 2) whether State Medicaid Directors
will self-report EVV implementation progress, 3) how stakeholders will be able to notify CMS of
challenges or successes regarding EVV implementation in real time, and 4) how states will recoup funds
for technology misuse and billing glitches.
CMS Response: EVV requirements, including implementation timelines, were included in the 21st
Century Cures Act, and any changes to these requirements would require an act of Congress. Please note
that the 21st Century Cures Act requires that states’ EVV systems must be conducted in accordance with
the requirements of HIPAA privacy and security law. In response to the first question above, Federal
Medical Assistance Percentage (FMAP) penalties are required by the 21st Century Cures Act and are
beyond the scope of CMS to amend. In response to the second question, states will self-report their EVV
implementation progress as part of the initial survey process to determine their compliance with the 21st
Century Cures Act. With regards to the third question, stakeholders are encouraged to submit feedback to
the EVV mailbox at [email protected]. Finally, in response to the fourth question, states will have their
own processes to address misuse of funds and/or billing issues. CMS does not mandate a specific process.
Action(s) Taken: CMS has and will continue to provide guidance to states on EVV implementation.
Please visit the CMS EVV website for guidance issued to date.
Comment 3: The Consortium for Citizens with Disabilities Long-Term Services and Supports Task Force
expressed concerns that the EVV Compliance Survey does not sufficiently address certain provisions of
the 21st Century Cures Act, specifically whether states have ensured that their EVV systems are
minimally burdensome, protect privacy, do not inhibit community integration, and take into account a
stakeholder engagement process. The Task Force suggested that the EVV Compliance Survey be updated
to include questions that address these aspects of EVV implementation.
CMS Response: CMS agrees with the Task Force’s recommendation to update the survey to include
specific questions that address 21st Century Cures Act provisions associated with the above aspects of
EVV implementation.

Action(s) Taken: CMS updated the EVV Compliance Survey with the following questions:
1. “Pursuant to Section 12006(a)(2)(A)(i), of the 21st Century Cures Act, please describe how the state
has ensured that its EVV system is minimally burdensome.” Please note that per Section
12006(a)(3) of the Act, Section 12006(a)(2)(A) does not apply to states that had an EVV system
in place prior to enactment of the 21st Century Cures Act and they therefore will not be required
to answer this question. These states will however have the option to provide this information if
they wish to do so.
2. “Pursuant to Section 12006(a)(2)(B) of the 21st Century Cures Act, please describe how your
state took into account a stakeholder process that included input from beneficiaries, family
caregivers, individuals who furnish personal care services or home health care services, and other
stakeholders when designing its EVV system.” Please note that per Section 12006(a)(3) of the
Act, Section 12006(a)(2)(B) does not apply to states that had an EVV system in place prior to
enactment of the 21st Century Cures Act and they therefore will not be required to answer this
question. These states will however have the option to provide this information if they wish to do
so.
3. “Pursuant to Section 12006(c)(3) of the 21st Century Cures Act, please describe how your state
has ensured that its EVV system does not: 1) Limit personal care services or home health care
services provider selection; 2) Constrain beneficiaries’ selection of a caregiver, or 3) Impede the
manner in which care is delivered.”
4. “Pursuant to Section 12006(a)(2)(A)(iii) of the 21st Century Cures Act, please describe how the
state has ensured that the EVV system is conducted in accordance with the requirements of
HIPAA privacy and security law (as defined in section 3009 of the Public Health Service Act).”
Please note that per Section 12006(a)(3) of the Act, Section 12006(a)(2)(A) does not apply to states
that had an EVV system in place prior to enactment of the 21st Century Cures Act and they
therefore will not be required to answer this question. These states will however have the option
to provide this information if they wish to do so.