Electronic Visit Verification Compliance Survey
CMS-10680, OMB 0938-New
Crosswalk of Survey Changes
EVV PERSONAL CARE SERVICES SURVEY
Slides 43 – 48 were added with the new survey items below. The PRA disclosure statement on Slide 49 was updated to increase the time required to complete the survey from 100-120 minutes to 130-150 minutes.
Slide 43: 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.
[check box] Description of how the state ensured that its EVV system is minimally burdensome. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
[check box] Not applicable. My state has not implemented EVV for any of the authorities in the 21st Century Cures Act.
Slide 44: 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, and other stakeholders when designing its EVV system. Please note that the statute does not require states that had a compliant EVV system in place prior to enactment of the 21st Century Cures Act to seek stakeholder input and they therefore will not be required to answer this question.
[check box] Description of how the state took stakeholder process into account for EVV design. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
Slide 45: 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 limit personal care services provider selection (1500 character limit text box).
Slide 46: 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 constrain beneficiaries’ selection of a caregiver (1500 character limit text box).
Slide 47: 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 impede the manner in which care is delivered. (1500 character limit text box).
Slide 48: 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).
[check box] Description of how the state ensured the EVV system is in accordance with HIPAA privacy and security law. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
EVV HOME HEALTH CARE SERVICES SURVEY
Slides 33 – 38 were added with the new survey items below. The PRA disclosure statement on Slide 39 was updated to increase the time required to complete the survey from 100-120 minutes to 130-150 minutes.
Slide 33: 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.
[check box] Description of how the state ensured that its EVV system is minimally burdensome. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
[check box] Not applicable. My state has not implemented EVV for any of the authorities in the 21st Century Cures Act.
Slide 34: 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 home health care services, and other stakeholders when designing its EVV system. Please note that the statute does not require states that had a compliant EVV system in place prior to enactment of the 21st Century Cures Act to seek stakeholder input and they therefore will not be required to answer this question.
[check box] Description of how the state took stakeholder process into account for EVV design. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
Slide 35: 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 limit home health care services provider selection (1500 character limit text box).
Slide 36: 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 constrain beneficiaries’ selection of a caregiver (1500 character limit text box).
Slide 37: 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 impede the manner in which care is delivered. (1500 character limit text box).
Slide 38: 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).
[check box] Description of how the state ensured the EVV system is in accordance with HIPAA privacy and security law. (1500 character limit text box).
[check box] Not applicable per Section 12006(a)(3) of the 21st Century Cures Act. My state had an EVV system in place prior to the enactment of the 21st Century Cures Act. (1500 character limit text box)
Update March, 2019
EVV PERSONAL CARE SERVICES SURVEY
Slide 11
Changed “No – My State has a waiver under this authority that delivers HHCS and is required to become compliant with 21st Century Cures Act” to “No – My State delivers PCS under this authority and is required to become compliant with the 21st Century Cures Act.”
Changed “N/A – My State does not have a waiver with this authority that includes PCS and therefore does not need to address this section” to “N/A- My State does not deliver PCS under this authority and therefore does not need to address this section.”
Slide 16: In the No response, replaced “HHCS” with “PCS.”
Slide 21: Same edits as 1a and 1b above.
Slide 26: Same edits as 1a and 1b above.
Slide 31: Same edits as 1a and 1b above.
Slide 36: In the No response, replace “HHCS” with “PCS.”
EVV HOME HEALTH CARE SERVICES SURVEY
Slide 11:
Changed “No – My State has a waiver under this authority that delivers HHCS and is required to become compliant with 21st Century Cures Act” to “No – My State delivers HHCS under this authority and is required to become compliant with the 21st Century Cures Act.”
Changed “N/A – My State does not have a waiver with this authority that includes HHCS and therefore does not need to address this section” to “N/A- My State does not deliver HHCS under this authority and therefore does not need to address this section.”
Slide 21: Same edits as 1a and 1b above.
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| File Created | 0000-00-00 |